Opioids Down in Doctors’ Offices Across the Country

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New York Times: Patients in Pain,

and a Doctor Who Must Limit Drugs

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By JAN HOFFMANMARCH 16, 2016

 

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MILFORD, Neb. — Susan Kubicka-Welander, a short-order cook, went to her pain checkup appointment straight from the lunch-rush shift. “We were really busy,” she told Dr. Robert L. Wergin, trying to smile through deeply etched lines of exhaustion. “Thursdays, it’s Philly cheesesteaks.”

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Her back ached from a compression fracture; a shattered elbow was still mending; her left-hip sciatica was screaming louder than usual. She takes a lot of medication for chronic pain, but today it was just not enough.

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Yet rather than increasing her dose, Dr. Wergin was tapering her down. “Susan, we’ve got to get you to five pills a day,” he said gently.
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She winced.
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Such conversations are becoming routine in doctors’ offices across the country. . . .

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“I have a patient with inoperable spinal stenosis who needs to be able to keep chopping wood to heat his home,” said Dr. Wergin, 61, the only physician in this rural town. “A one-size-fits-all prescription algorithm just doesn’t fit him. But I have to comply.”

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 When a random drug test of one longtime patient showed no trace of prescribed opioids, Dr. Wergin had to “fire” him for breaking the contract. Instead of taking the pills, the patient had been selling them.

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Dr. Wergin has learned to be even more wary during his emergency room shifts at the hospital 15 miles away. There, he has seen firsthand a growing number of overdoses and opioid-related deaths.

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The scenario has become so familiar that now when a nurse reports that the patient in Room 3 is complaining of excruciating back pain and asking specifically for Percocet, Dr. Wergin will reply, “And is he about 31, single or divorced, and insisting he is allergic to nonsteroidals?”

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These are “seekers ’n’ sellers,” he explained, who peel off I-80 and head for the hospital “thinking we’re just ignorant hayseeds.” A few months ago, state troopers pulled guns on one such man, who had stormed into the hospital demanding pain medications and threatening Dr. Wergin and other staff members.

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As Dr. Wergin recounted this, driving through the fog-shrouded back roads of winter-stubble prairie, where patients are rushed to the emergency room after being crushed by forklifts and tractor tipovers, he recoiled against his own cynicism.

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Prosecutors and medical review boards are increasingly scrutinizing physicians who prescribe controlled substances. A colleague of Dr. Wergin’s in a nearby community was investigated for two years after a patient died of an overdose. Although she was cleared, the reputation of her small-town practice was damaged. She moved to another state.

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The problems faced by Beverly TeSelle, 71, defy most solutions.

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After a second stroke that left her using a wheelchair, Mrs. TeSelle, formerly a gregarious accountant, began to suffer vicious headaches that left her weeping and moaning.

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“The biggest relief for both of us is when she goes to sleep,” her husband of 53 years, Larry, said, tearfully.

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Dr. Wergin noted that Mrs. TeSelle, whose strokes have also left her with slurred speech, and hand, arm and shoulder pain, already takes more than what may be allowed by coming state limits. He considered increasing the dose of her fentanyl patches but said, “I worry about respiratory depression.”

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