To curb opioid abuse, education of drug prescribers needed, public health officials say

An addiction to prescription painkillers or opioids is often the first-step to a heroin addiction, which is why Carroll County health officials say they are working to educate physicians and health care professionals about the addiction risks associated with prescribing them.

Although Sean O'Brien wasn't prescribed OxyContin, he said he didn't think much of taking the pills because they are prescribed by medical professionals with a medicinal purpose.

"I was drinking and smoking weed in high school — that was my thing in high school and just the crowd that I was with, and that evolved from drinking on the weekends and just a social thing — partying — to cocaine, to prescription pain pills, to just harder drugs," O'Brien said.


O'Brien's addiction to opioids soon became an addiction to heroin, he said. Both drugs produce a similar euphoric effect, but heroin is less expensive to buy and is stronger, making the progression an easy one for many with an addiction, he said.

"Once I did it one time, that was it," said O'Brien, who has been sober for almost 18 months and now works to help others struggling with addiction.

Educating doctors and health care professionals about the addiction risks associated with prescribing opioids as painkillers will be an important component of curbing the opioid and heroin epidemic sweeping the county and state, Carroll County health officials say.

In order to combat prescription drug abuse, Carroll and state public health officials say they are working to educate physicians who prescribe opioids to patients for pain about the growing number of people who become addicted to heroin after using prescription drugs. In October, the Obama administration announced an effort to curb prescription drug abuse and heroin abuse, stressing health care provider training on prescribing opioid pain medication.

"It has to start with [doctors]; they are the leaders," said Sue Doyle, director of the bureau of prevention, wellness and recovery for the Carroll County Health Department. The health department has partnered with Carroll Hospital and other health care providers to inform physicians and pharmacists about the country's opioid epidemic, she said.

"Access to the necessary resources in the community is a big part of what we are sharing," Doyle said. "We need doctors to know what services are available to assist their patients in the community when there is an issue."

The county health department is conducting outreach programs with physicians to educate them about the addiction risks associated with prescription painkillers, according to Doyle. Part of the outreach involves sharing the stories of individuals who started out with a valid prescription but began using heroin once they were addicted, Doyle said.

"This is what the doctors need to see because they don't hear these stories," she said.

If a doctor suspects someone is seeking drugs to feed an addiction and doesn't write a prescription, Doyle said, she also wants them to connect the individual to the health department to try to get them help.

In the past, users would first develop an addiction by being introduced to so-called gateway drugs, such as alcohol and marijuana, but now it is more common to see a heroin addiction develop from users of prescription opioids such as oxycodone, said Linda Auerback, substance abuse prevention supervisor for the Carroll health department.

Developing an addiction

O'Brien, now 30, said he became addicted to OxyContin, the brand name for oxycodone, a narcotic used to treat pain, at the age of 18 after first experimenting with the prescription pain medication as a 17-year-old student at Westminster High School.

O'Brien is not alone; many heroin users develop an addiction after first using prescription opioids.

"What is prescription drug use is turning into heroin use, because it's less expensive and it's more available," Auerback said.


For others, addiction to opioids begins as a legitimate medical prescription to manage pain.

Heather Coates, a peer recovery support worker for the county health department, said she was prescribed painkillers for chronic health issues when she was 17.

"At first it was great, because I could finally manage to do things, and leave the pain behind and get stuff done. But slowly by slowly the pain pills — I liked them a little too much. They took over," Coates said. "I kind of did the typical stuff with doctor shopping and if one doctor doesn't give them to you, you go to a different doctor, you don't use your insurance, you go to urgent care, ER, whatever it may take."

Coates said she knew something wasn't right, but excused it because she was in pain and because a doctor was prescribing her the medication.

"I wasn't meeting a dealer down on the corner, so I thought I was better than 'those' addicts, I guess," she said.

O'Brien said he believes health care professionals who prescribe opioids for pain management should be cautious.

"It is very easy to get addicted," he said. "The physical symptoms begin after only a couple days."


Dr. Khalil Freiji, who specializes in internal medicine, said he and his colleagues at Westminster Internal Medicine Associates developed a protocol years ago to screen newcomers and avoid taking on drug-seeking patients.

The practice does not treat chronic pain and makes that clear to patients, preferring to refer them to a specialist, Freiji said.

"We only treat acute pain; we utilize the least dosage that is most effective to control pain and we only prescribe for a short period of time," Freiji said. "Anybody that we feel is requiring more than a week of pain medication, we refer them to chronic pain management."

They also use a pain management screening tool for new patients to see what type of prescriptions they use and if they have prescriptions from multiple physicians called CRISP, or the Chesapeake Regional Information System for our Patients, which allows prescribers to access the state's Prescription Drug Monitoring Program online, he said.

"We can see if they have a history of drug abuse or if they're requesting [a] prescription from multiple physicians," Freiji said. That is why the practice screens every prescription that is controlled through CRISP before it is written for a patient, he said.

The protocol developed at Westminster Internal Medicine Associates is viewed as a model program by the Carroll health department's Auerback, who would like to share the information publicly with physicians in the community.

"Years ago the issue of lack of pain control amongst patients was a problem, so patients with terminal cancers were undertreated for pain," Freiji said. "Now we see that narcotic medication — opioids — are the No. 1 abused drug in the streets, so screening these patients effectively becomes a priority."

Physicians often walk a fine line of making sure patients in pain are comfortable but ensuring that they don't abuse prescription medication, Freiji said.

Dr. Miguel Macaoay, chief medical director of behavioral services at Carroll Hospital, said he struggles with whether to prescribe opioids and other narcotics to patients on a regular basis. Patients prescribed the drugs might suffer from depression, anxiety or insomnia, and might be in a situation in which the only drug that works for them is an opiate or benzodiazepine, Macaoay said.


"As doctors, we're dedicated to patients and want to alleviate suffering, but struggle with doing what is in the best interest of our patient … it's a very complex dynamic," Macaoay said.

In its final report released Dec. 1, the Heroin and Opioid Emergency Task Force appointed by Gov. Larry Hogan, recommends that registration and querying of the Prescription Drug Monitoring Program, a statewide electronic database of data on substances dispensed in the state, become a requirement for prescribers. There is currently no requirement for doctors to use the PDMP before prescribing or dispensing medication to patients, according to the report.

As of Dec. 29, no legislation had been pre-filed for the upcoming session of the General Assembly to implement the recommendation. Shareese Churchill, a spokeswoman for the governor's office, said the report is currently under review by the administration.

Macaoay said he believes requiring prescribers and dispensers to use a centralized, user-friendly PDMP would be a step in the right direction.

Freiji said enforcing the utilization of CRISP will help "tremendously."

"It will really give you an idea if a patient is a pain patient that needs help controlling his pain versus the ones that are strictly using this for abuse," Freiji said.

Jon Kelvey contributed to this article.