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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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Danny Gans, Dilaudid, and the Rising Issue of Prescription Drug Abuse
The Las Vegas Coroner just released that Danny Gans, the well known Las Vegas Entertainer, had toxic levels of hydromorphone (Dilaudid) in his system and died from an accidental overdose. We aren’t sure what happened here but as we have seen with Anna Nicole and Heath Ledger, prescription drug abuse is a complicated issue for all of us: physicians, pharmacists, and patients using opiate pain medications for appropriate reasons. As a physician there are times I resent that my triplicate prescribing information is tracked because I know my priority is serving the needs of those who require opiate pain medications for treatment of pain and discomfort. But we have a problem here, and we all need to acknowledge the problem. More and more folks are overdosing from prescription drugs. Prescription drug abuse is a rising problem and I ask you this: why does it seem that an overdose of Dilaudid is more acceptable than a Heroin overdose? Danny Gans was a talented and likable entertainer and how sad to lose such a young talented guy. Notice today, however, there are quotes from his agent describing him as “living a good, clean Christian life. He was not a drug user. He rarely drank and never smoked.” He was just found to have lethal levels of Dilaudid in his system. I take care of all-comers, opiate addicts of all kinds and I ask you this: is an opiate addict using heroin the same as a prescription opiate addict? Was this a painfully sad misstep for Danny Gans where he accidentally took too much or was his Dilaudid use an addiction resulting in increased use for the wrong reasons and eventually causing his death?
Do I think everyone who takes chronic opiates is an addict? ABSOLUTELY NOT. It is important to distinguish prescription drug abuse and addiction from physical dependence on opiate drugs, without addiction, that can and does occur within the context of good medical care. What is prescription drug abuse? Prescription drug abuse involves the use of a medication, usually by self-administration, in a manner that deviates from medical, legal and social standards. This is to distinguish it from the folks in our "chronic pain" DS community and the majority of my patients using it for appropriate reasons and as directed.
How big is the problem? Big. Prescriptions for opioid medications have increased annually since 1990, at least in part because of evolving attitudes toward the use of opioids to treat chronic pain, and the increasing prevalence of chronic pain with the aging of the population. While trends in the United States show a decline in the use of some illicit drugs, the abuse of prescription drugs is increasing. Why is this? Many reasons, including the misperception of pharmaceutical drugs as safe even when used outside of medical practice, their relatively low cost, and their wide availability.
Disturbing fact # 1: A survey of 50,000 US high school students in 2005 found that the number of adolescents who reported using illicit drugs in the previous year, compared to a decade earlier, was about 33 percent lower for eighth graders and 10 percent lower for high school seniors. However, the number who reported nonmedical use of prescription pain relievers or sedatives increased, with 7.2 percent of high school seniors reporting nonmedical use of sedatives and 5.5 percent reporting use of oxycodone products. Over 5 percent have used oxycodone??!!!??
Disturbing fact #2: The street value of diverted controlled drugs, as estimated by the US Drug Enforcement Administration, rivals the annual street value of cocaine and regularly surpasses the street value of both heroin and marijuana. Additionally, the ability to access prescription medications over the Internet has created a global market, with over 300 opioid "no prescription web sites" identified in one search.
Why is this difficult for Physicians who regularly prescribe these medications? Physicians are torn by a wish to expand access to controlled drugs to assure adequate treatment for pain and other disorders, and yet limiting access to those same medications to reduce abuse. Stories like this don’t help any of us. I believe Danny Gans had shoulder pain but I hope he exhausted all non opiate pain medications, physical therapy, acupuncture, topical medications and steroid injections before starting on Dilaudid.
I’m not sure what happened but I do know who is left suffering:
Andrew Gans, 19, said he would "deeply miss not being able to look up from the outfield and see my dad sitting in the stands watching me play ball. But it helps a little knowing he is standing right there beside me. He is my angel in the outfield."
Danny Gans RIP
Dr O.
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I have chronic pain and the tolerance of an elephant. At first, docs do not believe I ned something stronger or a stronger dosage. Then over the years, they begin to understand I am that way with ALL medications. I need strponger antibiotics, or a second round.
I take a pain reliever. It says 1 or 2 on the bottle but on bad days, two was not helping, I asked my doctor, 'Is it safe to take three?' I do NOT want to accidently OD myself.
It is possible some people unintentionly OD.
I have chronic pain but every few weeks I will forgo any pain meds to make sure that I do not get addicted. That would be horrible.
I am not an addict, I take my medications as directed by my pain management physician. I take 80 Mg's of Methadone a day. I do not get high from my medication, I get pain relief! Without my Methadone I wouldn't be able to get out of bed and walk my dog and have a semi "normal" life.
I hate when I see this "Hollywood Types" abusing prescription pain medications, because guess who ends up suffering??? We do!! Yes, we, we the patient's in chronic and/or intractable pain!
I just left my last PCP practice because she made a comment about "how many medications I am on"... I am only on Methadone for chronic pain, Zanaflex for my muscle spasms and 2 medications for my depression, that has come due to my intractable pain. I did NOT ask for this, I wanted to continue working as an ARNP for the rest of my life! I hope that Doctor's don't start judging everyone that is on opioid medications " A La" Michael Jackson! That would be soooo wrong!
These people in Hollywood pay $50,000.00 a day to have a "concierge" Doctor to give them whatever they want!! That is not me, and that is not the majority of the chronic pain patients in the United States, So please, please! Let's not use this that you have as a Physician to educate the general population on the plight of people that live in chronic and intractable pain, instead use it for the wrong type of education! The one that stigmatized opioid a little bit more, so people like me and other's will have to suffer when we can not get medicated thanks to Doctor's like you!
MINE ARE NOT FOR SALE!
BUT I DO KNOW that this man had legitament reason for these medications, and he still chose to sell them to people who did not need them, but was addicted to them. My brother was 26 years old, and in good health except for his addiction. So I have to disagree. EVERYTHING has a price, and my brother paid the greatest price of all his life.
I think Dr.'s need to keep on this topic, and not just hand out RX to anyone that walks in. Most people that have true chronic pain would not sell them, but I know for a FACT that some do.
This is a growing problem, and it has been out here a lot longer than some people want to acknowledge.
This topic needs to be addressed, it is not going to go away on its own.
Sinserely,
RhodaM (member of OVCA DS group)
His addiction to painkillers, plastic surgery, and most likely sexual addiction (based on the multiple accusations of pedophilia) all contributed to his death. You can't live with that level of high end self abuse and not have it catch up with you. Sure, doctors played a role here, but so did his family and entourage, who were unable to intervene and get him the help he needed. I don't know who the bigger villain was...Michael or the people he surrounded himself with. Sorry if that offends some of you who were fans...but the man did have his 'demons'. I have compassion, but I am also flabbergasted by the whole thing.