Why doctors risk jail time to treat pain and addiction

This is a strange time in America. While tools for treating pain and addiction, unchanged essentially from the late 1800s to the early 2000s, are now being developed, daring to try to utilize these medications and the science we have learned about them can be a huge risk. Not for the patient but for the doctor. There is a stigma that has always been attached to these areas of medicine, but things have shifted.

As of the latest statistics I can find, 48.7 million Americans experienced a substance use disorder in the past year. This used to be separated clearly from the diagnosis of addiction itself, which connotes a loss of control vs. controlled use, but it no longer is. 29.5 million have an alcohol problem, and of those, 70 percent will never receive any medical treatment. 8.0 million have both AUD and DUD.

Many of these potential patients are “self-medicating” comorbidity. Of those, only 9.1 percent will receive medical treatment. Marijuana is the most common illicit drug, used by up to 61.9 million Americans. Like alcohol, this is often a self-treatment for anxiety, depression, and stress, and now that safer and more effective treatment has been criminalized in America, pain. Things are not getting better anytime soon.

Prior to this new prohibition, we already did not have enough professionals dedicating themselves to the disciplines of chronic pain and substance use disorder. An article from 2019 lamented that only about 3,000 physicians had received specialized training to treat addiction and that there were only 2,200 board-certified and practicing pain management physicians.

2019 was also when the US federal government ramped up the prosecution of these professions that it had planned since 2017, essentially criminalizing physicians for what they cannot possibly know. Did your patient share a pill with a friend or family member? Did they sell one to an informant in a moment of weakness because they can’t work and need to pay rent or buy food? Do they have a criminal record?

Physicians do not have access to accurate law enforcement databases or a taxpayer-funded army of compromised and undercover citizens to answer these questions for them. But the feds do. Federal law enforcement has decided that, yes, you technically can treat these disorders; you better do so perfectly because two or three mistakes out of ten thousand patient encounters will incarcerate you.

Despite our country not having enough active nurses or doctors to properly care for our population, dedicated health care providers are being targeted for prosecution based on false metrics and impossible demands. Medical providers are being sent to prison for any excuse at all. A nurse for making a mistake in Tennessee, Dr. Bauer for treating pain, Dr. Reach for addiction, and Dr. Sasaki for whistleblowing.

It turns out that turning a giant corporation in for diversion can get YOU put away. Doctors are trying to help patients suffering from pain or addiction, and lately, anxiety or ADD also are disappearing. And now, hardly anyone wants to treat these conditions, creating a severe situation in our society where everyone is saying, “Get help,” but there is no effective help to get. How did we get here? And how do we get out?

The answers are genetics, epigenetics, stress, and access. Being a drug user was effectively criminalized decades ago as the possession of a Sweet N Low pack’s worth of crack was a mandatory two decades in prison at one point. Of the many factors influencing drug use, one that correlates strongly with this terrible condition is always access. This is sometimes key to developing a substance use disorder.

I grew up on a farm in rural America in a dry county and five miles from the nearest town. Alcohol and nicotine were the only drugs readily available to teenagers. The first destroyed the life of my father when I was only two, and the story of him failing to negotiate a Colorado curve and ending up with severe brain injuries made an impression on me.

As did the fact that he had abandoned my mother and two brothers, 4 and 6, almost a year before that accident. But the effect was the opposite for my brothers, both of whom played football and were popular, while I was a bookworm, often too shy to speak. They refused to let our father’s limitations determine what they could enjoy with their friends, and both developed lifelong alcohol problems.

It was not hard. Alcohol was everywhere… As were cigarettes, which also got a grip on them. Everyone smoked back then, even doctors and nurses, including my mother, a nurse who tried and tried to quit over the almost six decades of her career with limited success until lung disease incapacitated her. But when it came to harder drugs like heroin, it would have been almost impossible to develop a habit.

I’m sure it was available in bigger towns and cities like New Orleans, just seven hours away by motorcycle, but we never saw or heard about it. That gives a type of situational protection when you are young, but it also leaves you ill-prepared for temptation when you get older and move to other areas or are exposed to new work environments. However, some work environments are worse than others.

There are two professional areas that create a unique danger of developing substance use disorder. This is law enforcement and health care. Both have their own unique problems with ease of access and exposure to its effects. Police have it particularly bad, having less science-based education in this area, but since we are all emotional beings, health care professionals are still extremely susceptible.

Part of this susceptibility comes from the unique stresses of these two professions. No other areas of society demand perfection with the threat of prosecution when a layperson second-guessing points a finger. That nurse was sent to prison for grabbing the wrong vial of medication in an emergency. Police have been pilloried for not “knowing” that a teenager’s gun was unloaded when pointed at them.

The stress of this expectation, combined with long hours (sleep deprivation shuts off the frontal lobe as effectively as alcohol), creates an environment where the sudden urge to try something is hard to resist. Combine that with constant exposure and easy access to opioids and stimulants, and it’s not hard to see that normal human fatigue, depression, or just curiosity could lead to trying a forbidden substance.

Everyone is disappointed when someone we hold to a higher standard lets us down, but this is quickly combined with that dark glee we call schadenfreude at the realization that even these respected professionals have feet of clay when, in truth, we never should have expected them to be anything other than human in the first place. Case reviews are often the best textbook. Let’s look at a few.

And that brings us to Dr. Ralph Capone, Nurse Tara Severino, and Lieutenant Kevin Matthew. Dr. Capone had a medical office in Westmoreland County, Pennsylvania. This region of the country has been on a doctor prosecution tear, and I could argue that with a name like Capone, you might want to avoid the appearance of impropriety. I hope that’s not why the AI took a hard look at him.

According to the Office of the Attorney General, Dr. Capone diverted 268 prescriptions for hydrocodone syrup, which I suppose is Lortab Elixer. I’ve never needed to prescribe the liquid, but I’m sure it’s for people with esophageal strictures, gastric bypass, etc. There were reported to be a total of 332 prescriptions for this and other preparations like Hydromet syrup and plain hydrocodone pills.

These prescriptions were supposedly for his personal use, and it was said that he created them using the names of family members like his mother, brother, wife, and even his children. As the AG notes, this is not only illegal but could compromise his ability to practice medicine safely, saying, “We will continue to prosecute anyone who illegally abuses prescription drugs, including health care professionals.”

I would say not just including but “especially.” In the past, a compromised physician or nurse could expect to be offered some diversionary treatment with the goal of returning them to service. Those days are no more. Now, with completely digitized health care records and rampant physician prosecutions, it is always just a matter of time before the algorithm points its ghostly digital finger, and you go to prison.

People with substance use problems, when it crosses over into addiction, lose control of their ability to say “no” to the drug. That’s really what differentiates addiction from substance abuse without addiction or a habit that has not yet damaged someone’s life. Tara Severino was definitely out of control. She was an RN at a Veterans Affairs Medical Center in West Haven, Connecticut, when she started stealing drugs.

First, ingesting drugs like fentanyl, hydromorphone, and oxycodone that were going to be disposed of… And then stealing the same from patients who were being treated for severe pain from conditions as severe as cancer. Stealing pain medication from a patient who is dying from cancer is one of the worst things a health care provider could do… But that’s what happens when people lose control.

They will steal from their mother, neglect their children, and lose everything that had been important in their lives, all to maintain their addiction. It’s important to understand that since these chemicals hijack the same brain center that gives us pleasure from family and our lives, this is indeed a type of toxic love. Nothing makes someone feel more bliss than addictive substances like methamphetamine and fentanyl.

That’s because while our natural endorphin release, triggered by dopaminergic neurons extending from the ventral tegmental area to the nucleus accumbens, lasts for only a few seconds, these drugs last for tens of minutes or even hours. It is hard for anything in our lives to compete with this hyperstimulation of the reward center of the brain itself, and the circuit quickly reinforces the behavior.

This brings us to Lieutenant Matthew of Cedar Grove, New Jersey. Lt. Matthew had started removing cocaine and fentanyl from the evidence locker without authorization. Matthews was part of the Special Victims Unit, not narcotics, and despite filling out the right digital forms, this raised red flags. He was caught and is being prosecuted, facing five to ten years in state prison.

He is also vulnerable to federal charges if they feel like it. As he was committing a crime under the color of law. Worse, he was in possession of a firearm during the commission of a drug crime. Will his sentence be doubled like the pharmacist Noel Jackson, who had a gun in his pharmacy after a robbery? Probably not. Laws are selectively enforced in America, and police usually get special protection.

That doesn’t mean he is safe. Every now and then, the powers that be will throw someone to the wolves in the most despicable way, not because they individually deserve it, but to create the appearance of a counternarrative they can point to if some rich and or famous person gets the medal of freedom instead of prison. All that being said. Do not assume that things will go well for you if you have lost control.

This country has little mercy for human frailties these days, and you will almost certainly be one of the usual and not the exception. So I implore you. If you are a medical professional or law enforcement officer, and you have lost control of what probably started as a curiosity or depression-based action. Get help now. Do not wait for them to kick in your door. There is no effective drug treatment in prison.

Oh, I know, you’re asking, “How can I afford that?!” and “How will the team get along without me?!” Let me answer those questions because it won’t cost you everything, like getting caught will, and they’ll get along just fine. Probably better since your performance always slips whether you know it or not. And don’t go halfway by expecting a once-a-week counselor to heal you if it has gone this far.

Go big. Find a residential treatment center out of state that has an in-house detox facility and trained staff. I toured one of these recently for this article. Situated in a gorgeous location in the Ozarks, not far from the crystal clear waters of Beaver Lake near the beautiful Victorian town of Eureka Springs, Arkansas, these people have done it right, which is a rarity. I have so often seen the opposite.

They have a fully staffed medical detox center, an addiction specialist certified physician medical director, an incredible therapist with a master’s degree in addiction psychology, a chef with amazing skills, himself a recovered addict, and a staff of kind and knowledgeable people. This is the only facility of its kind that I’ve seen anywhere, though I’m sure there are many in California and Arizona.

The critical thing here is not the scenery or the facilities, though that helps, but the absolute dedication and compassion evidenced in the attitudes of the staff. It’s the last that I have found wanting in other programs. I have seen adult men being blamed for their addiction to the point of tears. The Marines tear you down to build you up; in these places, they tear you down to leave you broken on the floor.

This does not help people heal. You did not choose your genetics. 20 percent of the population carries an increased genetic risk for opiate addiction and about the same for alcoholism. The stress experienced by your grandparents can cause epigenetic changes that are carried down to you. And you didn’t choose your childhood and school environment. You did not make all these choices.

But you can, as soon as you recognize the problem, decide to get real help. At this facility, you can keep your phone and have visits from your family. They offer SMART recovery as well as 12 steps. In short, they try to make sure their programs work for you rather than trying to hammer you into what they need. There is a difference between comprehensive, compassionate addiction care and everything else.

That difference can bridge the gap between feeling abused and swindled or experiencing a truly positive change in your life that makes a lasting change. It won’t be easy, and it will take a lot of hard work; every important thing in life always does, and at some point, you will stop using your drug of choice. Just don’t let it be when you stop breathing.

L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues. 

He can be reached on LinkedIn and YouTube.

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