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One doctor's crusade against the US pain pill abuse epidemic

Robin Wulffson MD's picture
substance abuse, Vicodin, pain pills, pill mills, pain relief, teen addiction

Chronic pain is a nationwide problem that affects 116 million Americans, costing $560-$635 billion annually in direct medical treatment costs and lost productivity. In addition, pain pill abuse is of epidemic proportions. In addition to treating patients with chronic pain, David S. Kloth, MD is an advocate for healthcare reform.

Chronic pain is a nationwide problem that affects 116 million Americans, costing $560-$635 billion annually in direct medical treatment costs and lost productivity. In addition, pain pill abuse is of epidemic proportions.

David S. Kloth, MD, who practices at the Connecticut Pain Care, PC in Danbury, Connecticut is a specialist in interventional pain management and a member of the American Society of Interventional Pain Physicians (ASIPP). In addition to treating patients with chronic pain he is an advocate for healthcare reform; however, he does not feel that the Affordable Care Act is the solution. For the last several years he has served as spokesperson for several medical societies, advocating for patients’ rights to receive medically appropriate pain treatments.

Dr. Kloth notes that abuse of pain pills is a “multifocal problem,” involving state and federal governments, physicians, insurance companies, patients abusing medications, and “pill mills” that dispense hundreds of potent and addictive narcotics on a daily basis. He explains, “Vicodin is the most widely prescribed medication in the United States, well ahead of cholesterol-lowering drugs and blood pressure medications.” He notes that 99% of the world’s supply of Vicodin (hydrocodone) is consumed in the US. A major source is “pill mills,” which hire physicians in need of income who prescribe prescriptions to all comers. Although many of these facilities present themselves as pain clinics, they rarely order tests or offer referrals to pain experts. On return visits, the patient receives another prescription. These “pill mills” operate throughout the nation. Some of these patients generate income for more drugs when they receive a prescription. One ruse is to ask that a prescription for a narcotic be divided into two prescriptions: one for 50 and another for 40. The “patient” then sells the one for 50 to generate funds to buy the other 40.

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Another source of narcotics is unused medication falling into the wrong hands. Dr. Kloth cited an example: a dentist writes a prescription for 30 Vicodin; the patient takes them for two days, leaving 20 pills languishing in the medicine chest. His kids discover them and embark on the rocky road to drug addiction. Sadly, notes Dr. Kloth, this is a major healthcare problem. "Pill mills" commonly dispense the potent 30 mg dose of Vicodin,; he feels that the main use of this dosage should be for patients with progressive and terminal cancers. Currently, Vicodin is a Schedule III controlled substance, which means a physician, or a drug abuser posing as a physician, can phone in a prescription. Dr. Kloth is lobbying to move Vicodin up to a Schedule II level, which has stricter prescribing requirements.

Pain pill abuse is a societal issue; depressed individuals resort to narcotics to boost their mood, and relieve anxiety. They are pill-oriented and feel that many problems can be fixed with a pill. The current economic downturn is fueling substance abuse. Physicians as well as patients are part of the problem. Dr. Kloth notes that most physicians—about 80%––are not well trained in prescribing opiates. ASIPP has developed a twelve hour course that can bring a physician up to speed in this area. In addition, some states are looking into requiring training for physicians who prescribe opiates. Dr. Kloth and his colleagues treat patients with minimally invasive procedures. They offer non-opioid treatments such as trigger point injections, epidural (space just outside the spinal cord) injections, facet injections, radiofrequency ablation, minimally invasive disc surgery, and implantable devices. Unfortunately, however, health insurers deny them. This leaves the legitimate pain sufferer with the only alternative—to pop pain pills.

Dr. Kloth notes that pill mills and substance abuse are adding to costs in Medicaid/Medicare and that we as tax payers are footing the bill. . He said, “When I think about [healthcare] reform, I think about cleaning up waste like this.” He notes that state sharing of prescription drug monitoring programs (PDMP) are not controversial, just expensive. ASIPP wants to see full funding of the National All Schedules Prescription Electronic Reporting (NASPER). Full information on NASPER is available at this link.

Reference: American Society of Interventional Pain Physicians

See also:
Closer scrutiny of prescription drugs recommended to protect public
Sad statistics regarding fetal harm from maternal drug use
Drug addicted newborns: a national disgrace



I disagree with dr kloths solution.we shouldnt be making doctors better at over relying on medications. Instead we sbojld educate them in nonpharmacological treatments for pain and require them to make effective and safe use of all treatments for pain.
Dr. Kloth wants physicians to be better educated regarding opiate prescribing. However, the thrust of his advocacy is to get alternatives to narcotics approved by health insurers.
I am sure dr kloth will continue to serve the best interests of the asipp and his colleagues in medicine.And advocates like myself will continue to serve the interests of people in pain.
Physical pain is no longer tolerated and is avoided by the use of opium derivatives in pill form. This is good news for doctors; most patients are pain suffers who often return for refills. But a competitor has arisen in the form of an unemployed youngster who is offering the same product at a discount. The source of supply for the young drug dealers are patients with medical insurance coverage, they get the pain pills for free and by selling them on the open market their incomes are supplemented. It is a money maker for everybody but doctors whose waiting rooms are now only half full.