Patients Telling Tales: Stories That Can Teach Us How to Combat the Opioid Epidemic

By: Jill Mattingly, DHSc, MMSc, PA-C
Mercer University, Atlanta

He sat comfortably in the overstuffed chair in the dimly lit room. He had just started a buprenorphine induction in our clinic and was on the other side of his moderate opioid withdrawal symptoms. The patient, I’ll call John, became more talkative than when he arrived for his appointment earlier in the day. The conversation moved to the genesis of his unfortunate journey into opioid use disorder (OUD). It was simply a dental procedure, a generous prescription of opioids for longer than needed, and a new, wonderful sensation. He quickly used up that first prescription and immediately started to think of ways to get a refill. When asked about the way he felt when he used the medication, he lit up and recounted how it changed evenings in his home. When he used the medication after work, it made his life brighter and more enjoyable. He played with his kids more and spent quality time with his wife. Inevitably, his daily use led to tolerance and the need for more dosing just to keep from getting sick. The usual ways of obtaining more medication were difficult and unpredictable, and he started becoming an expert at finding more prescription opioids. 

The most creative way he found more of these prescription narcotics was to search the real estate announcements of open houses in upper-middle-class neighborhoods. He would put on his most professional suit and proceed to attend several each weekend as a prospective buyer. During the showing, he would excuse himself to use the restroom and make his way to the owner’s bathroom. Amazingly, he would almost always find bottles of prescription opioids and benzodiazepines in the medicine cabinet. He was careful to take only what would not be immediately missed and then resume his ruse with the realtor.

During her follow-up maintenance appointment, my buprenorphine patient, I’ll call her Jane, brought proof of her exhaustive attempts prior to her OUD treatment to ensure she would never run out of her prescription opioids. She propped up a desk size monthly calendar on the chair beside her and flipped the pages month by month. Each square was filled with writing, except for the Sunday squares. 

Upon further inspection, I saw that each day had a name and address of a physician or a clinic followed by medication names and pill numbers. Jane had successfully built a schedule of a different clinic each day of the month. 

This was before any state was using the Prescription Drug Monitoring Program (PDMP) so she had at least 20 clinics that were not savvy to her technique. Each clinician unaware of the other, providing Jane with 30 – 90 pill prescriptions. Keeping this schedule was a full-time endeavor devastating her finances and family.  

 Both of these patients had progressed to 20 – 30 hydrocodone pills a day before seeking treatment for opioid use disorder (OUD). 

Previously, each had found a way to get what they needed through deception or theft. John taking from unaware homeowners, and Jane is developing a doctor shopping schedule. Over the last ten years, the opioid epidemic has helped uncover these deceptive techniques, and clinicians are at a better vantage point to help patients avoid these pitfalls. With the implementation of the PDMP in many states, studies have found that it has been effective in preventing drug abuse, diversion, and doctor shopping. Several years ago, the American Medical Association encouraged consumers to safely store opioids at home by securely locking the medication cabinets. Locking these prescription medications up at home not only protects children and adolescents, but it also provides a barrier to any other drug seeker that may access the home. 

See Jill Mattingly, DHSc, MMSc, PA-C speak at the GAPA 2021 CME Conference in Hilton Head Island, SC July 12-16, 2021.

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