Monday, February 4, 2013

Another Sad Story: Prescription Therapy Gone Awry

The front page of the Sunday New York Times yesterday featured the sad story of Richard Fee, a bright, talented baseball player who, as the title of the article states, Drowned in a Stream of Prescriptions.  His particular addiction was Adderall, an amphetamine-based medication used for the treatment of ADHD, a diagnosis which was questionable at best in Richard’s case. 
The story resonated with me, though, because of its implied indictment of our collective approach to any form of care delivery that might take more than a five minute office visit or a thirty minute trip to the operating room.  In particular, I saw themes throughout the article indicative of our culture of overtreatment and overreliance on prescription medication.  We’re dealing with more than just an opioid problem.  We’re dealing with more than just a chronic pain problem.  The fundamental model of care delivery is broken.
Below, I’ve taken several quotes from the Times article and simply removed the name of the drug and the diagnoses.  Ask yourself: How many injured workers do you know that fit the descriptions below?
“Through the remainder of 2010, in appointments with Dr. Ellison that usually lasted under five minutes, Richard returned for refills… Records indicate that he received only what was consistently coded as ‘pharmacological management’ – the official term for quick appraisals of medication effects – and none of the more conventional talk-based therapy that experts generally consider an important component… of treatment.”
“His [prescriptions] were always for the fast-acting variety, rather than the extended-release formula that is less prone to abuse.”
“Virginia is one of 43 states with a formal Prescription Drug Monitoring Program… Although pharmacies are required to enter all prescriptions for controlled substances into the system, Virginia law does not require doctors to consult it.” 
’The doctor wouldn’t give me anything that’s bad for me,’ Mr. Fee recalled his son saying… ‘I’m not buying it on the street corner.’”
“He had it in his mind that because it came from a doctor, it was OK.” 
DeAnsin Parker, a clinical neuropsychologist in New York: “Diagnoses are made just this quickly, and medication is filled just this quickly.  And the lack of therapy is really sad.  Doctors are saying, ‘Just take the meds and see if they help.’”
Richard Fee eventually took his own life, unable to deal with his addiction and its consequences. 
We must do everything we can to stop addiction before it starts, provide alternative non-pharmacological therapy wherever we can, and help safely wean those already addicted to medications that are doing more harm than good.  This won’t be easy and it won’t be cheap.  But we have to do it anyway.
On Twitter @PRIUM1

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