Lack of prescription med oversight forces doctors to improvise

Feb. 12--COLUMBUS -- Dr. Dan Wik tests his patients with long-term opioid prescriptions every four months or so.

He's checking to make sure patients are using their medications as prescribed, not taking large doses to get high, selling the pills on the street or mixing them with other drugs.

Every patient is tested -- no exceptions.

"In God we trust; everyone else pees in a cup," said Wik, a Norfolk physician who also works with Columbus Community Hospital.

Wik is adamant about testing because it's one of the few tools Nebraska physicians have to identify prescription drug abuse. Wik also requires patients to sign a prescription contract so other doctors know he's the only one who can prescribe certain drugs -- narcotics, opioids, muscle relaxants -- to his patients. He relies on a network of pharmacists to inform him when his patients behave suspiciously, such as running out of medication early or having more than one prescription.

The most common excuses he hears for missing medications are that the dog ate them or they fell down the toilet.

"There's a lot of dogs out there that don't have any pain at all," said Wik. "And the vitamins never get spilled down the toilet, the hypertension drugs never get spilled down the toilet, the diabetes drugs never get spilled down the toilet -- only the opioids."

The current system in Nebraska for tracking prescriptions is woefully inadequate -- not all prescribers and dispensers have access, patients can opt out and Medicare patients and those who pay with cash are not recorded.

The Lincoln Journal Star reported that people from 38 other states come to Nebraska to fill narcotic prescriptions, including 300 people from Florida after that state tightened its monitoring program.

Nebraska and Missouri are the only two states that don't have functional statewide prescription medication monitoring. A bill proposed by Sen. Sarah Howard of Omaha would institute and fund a statewide monitoring program that would be compulsory and free for physicians and pharmacists.

Wik is a pain specialist who treats people especially vulnerable to prescription addiction, those with long-term or chronic pain. Through testing, he's found that around 15 percent of his patients are not complying with their prescriptions. And he is concerned that physicians who are not as thorough probably treat a higher percentage of addicts, abusers and dealers.

"Their ignorance is why we have an unregulated black market of drugs," said Wik. "Addiction is very, very powerful and addicts are very, very smart. Therefore, if you do not drug test, that would be a place that addicts would tell other addicts to go to because you could get easy drugs."

Rebecca Rayman, executive director of East Central District Health Department, said that because of the inability to monitor prescriptions, the health department is very judicious in its use of narcotics.

"We hardly ever provide narcotics or some of the more addictive medications," said Rayman. "Instead, we refer a lot of people to pain specialists."

Pain specialists, such as Wik, can determine if the pain described by the patient matches what they see on MRIs or CT scans. When a patient becomes addicted to medication, they'll feel psychosomatic pains that don't match their physical condition.

"There is a pain that comes with addiction," said Rayman. "If you don't handle that, the addiction will continue."

Wik said there are a variety of alternatives to strong narcotics and opioids to treat pain, which he turns to when a patient abuses or misuses their prescription medication. Suboxone is often prescribed for opioid addiction because it relieves pain, including withdrawal symptoms, but does not give the same high as opioids.

Physicians whose patients die from prescription overdoses can be held liable under manslaughter charges if investigators determine they did not test and adequately track their patient's medication use.

In cases where a patient may be selling their medications, law enforcement will only get involved if they catch the dealer in the act, such as the case of Ricky Johnson, a Columbus man who allegedly sold Tramadol to an undercover agent in December.

Investigators are not sure how Johnson acquired Tramadol, but there are some common methods for acquiring prescription drugs. Wik said some of the easiest places to get medications are at dentists' offices or urgent care centers. Dealers will also enter the homes of the recently deceased, during a wake or funeral, and raid the bathroom cabinets. Columbus Police Investigator Jeremy Zywiec said sometimes they will knock on someone's door and ask to use the bathroom, then swipe their medications.

The Department of Health and Human Services reported in September that from January to July of 2015, 84 drug overdose deaths were reported in Nebraska and the majority involved prescription or illicit opioids.

If Howard's bill becomes law, the monitoring system would take effect Jan. 1.

Copyright 2016 - Columbus Telegram, Neb.