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home : most recent : statewide implications August 20, 2017

7/30/2017 12:35:00 PM
Mishawaka slaying shows tough balance doctors face with opioid prescriptions

Christian Sheckler, South Bend Tribune

A few times each year, as the opioid addiction crisis has accelerated, a handful of doctors across Indiana have made headlines after police raided their offices and arrested them on charges of recklessly writing prescriptions for powerful pain medicine.

This week, authorities said, a local doctor did the opposite by refusing to prescribe an opioid — and paid with his life.

The Wednesday shooting death of Dr. Todd Graham, who practiced at South Bend Orthopaedics, was an extreme example of the ire doctors risk when they deny painkillers to a patient, just as the arrests of doctors are the rarest cases of over-prescribing. 

But the dispute that led to Graham’s death stands out as a jarring example of the balancing act doctors face on the front lines of the war against opioid abuse.

On one hand, new laws and regulations have increased the pressure on doctors to use caution when prescribing pain medicine and to be on the lookout for fraud by using drug tests and other measures. On the other hand, patients with a legitimate need for pain relief have been frustrated by the new obstacles.

“We all live under a little fear as patients have felt the tightening of laws and regulations regarding opioids,” said Dr. Natali Balog, a rheumatologist at South Bend Clinic and president of the St. Joseph County Medical Society.

“Even our normal patients who are very straightforward, they feel criminalized.”

Reacting to the epidemic of abuse and overdoses from heroin and related opioid painkillers, Indiana’s legislature in 2013 passed a law that set up a host of new rules for primary care doctors who prescribe opioids.

Experts have said many heroin users become addicted to opioids after being prescribed the painkillers for legitimate injuries or chronic pain.

As recently as 2012, Indiana was among the 13 U.S. states that prescribed the most opioids per capita, according to the U.S. Centers for Disease Control and Prevention. That year, more than 100 opioid prescriptions were written for every 100 people in Indiana.

Last year, about 6.42 million opioid prescriptions were filled in Indiana, a slight drop from the 6.46 million prescriptions dispensed in 2015, according to a study published by the Center for Health Policy at Indiana University’s Richard M. Fairbanks School of Public Health.

To get a prescription of 60 pills or more from a primary care physician, the 2013 law requires a patient to fill out an addiction questionnaire and other paperwork, sign a pain-management contract and submit to a physical and urine test.

Related Links:
• South Bend full text

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