The Pain Problem

Written by on May 3, 2012 in Features - No comments

According to the Office of National Drug Control Policy and the most recent survey of drug use among young people, prescription drugs are the second-most abused category of drugs after marijuana. In addition, the latest National Survey on Drug Use and Health shows that over 70 percent of people who abused prescription pain relievers got them from friends or relatives, while only 5 percent got them from a drug dealer or over the Internet. This practice of “drug diversion” occurs daily when a drug that has been prescribed by a physician is “diverted” in some way by the person for which it was originally prescribed, either intentionally or unintentionally. Either way, doctors are now being held increasingly responsible for the diversion of the drugs they prescribe.

“Where the historical attitude toward prescription opioids was that the doctor prescribed and then the patient was responsible for the use of the prescription has changed,” explains Robert Saenz, a national expert in the area of drug Misuse, Addiction and Diversion (MAD). “Now, doctors can be held just as liable for what happens with the medications they prescribe.” Saenz manages, coaches and advises physicians across the country on the very necessary elements of safeguarding medical practices from MAD situations. Saenz tries to get the doctors in the middle of the spectrum – there are docs who are prescribing too many drugs or not prescribing at all – there is a happy medium.

Saenz teaches physicians how to monitor their patients. Saenz says that the vast majority of doctors losing their licenses are in the older spectrum because prescribing opiods has never been an issue before… but it is now and they are going to prison for their involvement. For example Texas physician was recently indicted for his part in an “illegal pain management operation” involving three clinics and four pharmacies. The Drug Enforcement Agency (DEA) charged 76-year-old Gerald Ratinov, MD, with allegedly running the pain pill operation. Ratinov at one time served as medical director for three Houston pain clinics that were targeted in several other DEA raids. “I am not surprised by the recent arrest,” Saenz said. “Doctors need to guard themselves against these types of liabilities and threats.”

So what are doctors to do? Saenz believes there is plenty of room to both help patients while avoiding the potential for prescription drug abuse. “By implementing a functional based treatment plan, where compliance auditors carefully review treatment plans which include functional goals alongside the medical professional, the risk for medical practices (when it comes to drug diversion) can be avoided successfully without a reduction in quality of care,” says Saenz.
Saenz is also the CEO of Tulsa Pain Consultants in Tulsa, O.K. Tulsa Pain Consultants is a group of four pain management experts who believe in the safe and responsible management of pain on an ongoing basis with their patients and referring physicians. Oklahoma is one of the first states to implement a statewide database that keeps track of prescription history so if there is a question about a particular patient’s propensity toward drug-seeking behavior, it can be included or ruled out as a factor in a higher risk scenario. Due to the profound success rate of this system, the state of Oklahoma recently asked Saenz to write legislation for the State of Oklahoma on the subject of drug diversion.

The following are a few safeguards that Tulsa Pain Consultants have implemented to keep patients and doctors safe:
• Conducting background checks on all new patients to ensure that no prescriptions are givento patients with a history of unlawful distribution prior to prescribing them with opioids.
• Using urine drug screens prior to and after prescribing opioids to ensure the meds are being taken and not sold or diverted.
• Checking all patients in the Oklahoma Bureau of Narcotics database to insure they’re not already receiving prescription opioids from another doctor (to prevent doctor pill shopping).
• Providing other treatment modalities coupled with appropriate medications to reduce a patient’s chances of dependency such as steroid injections for pain, spinal cord implants for chronic pain and even acupuncture.
• Meeting with patients individually and having them sign a medication contract outlining specifics of their responsibilities as a patient while taking and securing their prescribed opioids.

While some of these measures may seem strict, the question a physician must concern themselves with is whether or not there is an inherent potential for harm to the particular patient. “Often times this question of harm must be assessed based on various indicators, Saenz says. “If markers point to the potential abuse of the prescriptions, then patients not only run the risk of harming themselves with recreational drug usage, but also from not taking the medication as prescribed. Ultimately we must stand by the physician’s first responsibility, which is to “do no harm.” Saenz says that patients should also be educated with regard to the medicine they are being prescribed; they cannot and should not completely rely on their physician alone.

To find more information on Tulsa Pain Consultants please visit:

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