When I read about the arrest of a person like Steven Parry, a Hauppauge osteopath who’s accused of prescribing 750 pills to a Long Island woman just 20 days after she had overdosed, I think the opioid crisis is well in hand. But in reality, such extreme cases are the easier ones to detect. Day-to-day overprescribing for routine health issues like a pulled molar tooth, back pain or a broken bone — that’s what alarms anti-addiction advocates.
“We’ve done a good job of locking up the bad actors,” says Jeffrey Reynolds of the Family & Children’s Association treatment center in Mineola. “They’ve been driven out of business, or they understand the game has changed. The other 99.9 percent need more guidance . . . . They’re not doing criminal things, they just haven’t had the education.”
The Centers for Disease Control and Prevention recently recommended that doctors prescribe no more than three days' worth of pills such as Vicodin or Percocet for an acute problem like a root canal or a sprain during a lacrosse practice. But health care professionals often prescribe 12 or 30 or more.
Opioid pills were linked to 343 deaths on Long Island in 2012 and 2013. Deaths involving opioid painkillers have been leveling off since 2012 when New York began tracking prescriptions through a database called I-STOP — Internet System for Tracking Over-Prescribing Act. But I-STOP had the unfortunate unintended consequence of making heroin cheaper than pills and more attractive as a way to get high. Still, government statistics show that deaths involving opioids continue to outpace heroin-related deaths.
Collectively, we must overcome this. It’s important to help people live abundant lives, not bleed their lives away in counterfeit euphorias that erode their health and break their spirits.
I-STOP passed the State Legislature after the 2011 Father’s Day murders of four people in a Medford pharmacy by a man seeking opioid pills for his wife. The legislation omitted a requirement for physicians and dentists to take a three-hour class every two years on managing pain, palliative care and addiction. The Medical Society of the State of New York opposed the class as burdensome, when physicians spend 50 hours a year or more in continuing education. After two defeats, advocates have not submitted the bill again this year.
However, there are signs that the medical community is taking opioid abuse more seriously. Leading medical and dental schools are voluntarily adding instruction on prescribing painkillers to the curriculum. “We’ve been partially there, and we’re going to be doing more. We’re incorporating it,” said Dr. Ronald Kanner, an associate dean at the Hofstra Northwell School of Medicine.
The Food and Drug Administration announced this week that it will add its most serious warning — like the warning on a pack of cigarettes — to immediate-release opioid painkillers. And the American Medical Association posted training modules on its website suggesting physical therapy, massage, yoga, acupuncture and other pain relief efforts before pills.
The pendulum has perhaps swung too far in favor of medication, says Kanner, who was among the first pain management fellows at Memorial Sloan Kettering in 1979. “There are doctors who are well-meaning who don’t take the time or don’t understand fully what the potentials for abuse are,” he said.
In his practice, which treats chronic pain, Kanner is very direct with new patients. He asks whether they’ve ever had a problem with drugs or alcohol — and even whether they smoke — to weed out those susceptible to addiction.
Hofstra’s right to teach all student doctors to be so careful.
First published in Newsday.