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Column: MDs aiding prescription abuse

My column in today’s The StarPhoenix

A well-known drug addict went to four doctors last summer and got four prescriptions for morphine on the same day. He had the prescriptions filled at different pharmacies, which gave him more than enough morphine to abuse, sell or trade.

That’s exactly the kind of abuse that the province tried to prevent in 1995 when it introduced the Pharmaceutical Information Program (PIP). It’s a computer network designed to help doctors and pharmacists keep on top of what is being prescribed, to make sure there are not any drug incompatibilities and, as PIP’s goals state: "Provide information needed to minimize drug abuse, diversion and misuse."

That didn’t happen in this case.

Usually the system works well. I am a Type 2 diabetic who keeps it under control by taking two medications – Metformin and Glyburide. I get my prescription from my doctor, who gives me some refills. When the refills are done, I need to return to see him. After talking and checking me over, he enters a new prescription into the computer which I can then take to the pharmacy.

This is for two drugs that have absolutely no street value and aren’t narcotics, but they are still tracked by PIP. It’s the same for most of us prescribed medicine, if the doctor is doing his or her job.

However, for some a prescription is a gateway to other drugs. Ritalin is a good example. One woman I know sells her Ritalin so that she can buy another guy’s morphine to shoot up. Obviously her ADHD was under control enough that she could complete a drug deal and still be focused enough to get high.

In a couple of weeks she’ll get her refill and the cycle will continue, probably until a dirty needle ends it for her.

How common is this? A 2007 report by the Canadian Centre for Substance Abuse notes there is "minimum" research in the area of prescription medication abuse. The few studies that do exist state that about 10 per cent of patients at rehab centres are getting help for prescription drug abuse.

A study of seven Canadian urban centres showed that about 30 per cent to 40 per cent of drug users are abusing at least one prescription narcotic, with drugs such as Percodan being the favourites. A 2006 study in the Canadian Medical Association Journal showed that morphine and OxyContin are replacing heroin as the drug of choice for many Canadians.

How do they get these drugs? Double-doctoring is a big part of the problem. You get a prescription from one doctor, and you go to another and present the same symptoms. If the first (second, third or fourth) prescription doesn’t get entered into PIP, you get your drug supply.

PIP does try to take care of privacy concerns and allows people to "opt out," which I have been told by addicts makes it easier to get their prescription. While many doctors won’t prescribe narcotics if someone has opted out of the program, some others do.

More disturbingly, some doctors will prescribe what you ask for. Someone I knew proved that three years ago by walking into a doctor’s office and saying his back was sore.

He came out with a prescription (and refill) for morphine. This doctor had a reputation for "giving you what you wanted," which, as you can guess, often is narcotics.

Why is it a big deal? There’s the moral aspect, but there’s an economic side, as well. You and I pay for these drugs prescribed to people on the provincial supplementary health program.

Depending on how you look at it, the provincial government is either the biggest drug dealer in Saskatchewan or the biggest enabler, with our backing.

You can’t tell me it’s impossible to stop or curtail this problem. Saskatchewan has centralized drug purchasing, centralized medical billing, and the centralized PIP in place, and yet the abuse continues. I know that physicians are independent contractors, but if a doctor writes an abnormal amount of prescriptions for OxyContin, morphine or other narcotics over an extended period, why isn’t that investigated? Why aren’t red flags raised at pharmacies when multiple prescriptions for the same drug are being filled? Finally, why isn’t the Health Ministry getting involved when these cases slip through?

I know that our society puts doctors on a pedestal. Believe me, when I am sick, I want to be treated by a good one. However, if because of profit, incompetence or laziness, doctors are hurting the people they took an oath to help, we need to get them out of the system. Saskatchewan won’t ever need doctors that badly.

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