Pain in the Heartland

Far too often we hear about pill mill doctors who are shut down or even arrested. Rachel Aviv’s article “Prescription for Disaster” (The New Yorker, May 5, 2014) (subscription only) provides insight into the disturbing details of what led one such doctor, an osteopath named Stephen Schneider, to prescribe large amounts of opioids to many of his patients.

Aviv writes that it all started in 2005 when the Wichita medical examiner discovered a “cluster” of suspicious deaths of 16 men and women who had died in their sleep. All had received “scripts” for painkillers from the Schneider Medical Clinic, which had opened its doors in 2002 in Haysville, a working class suburb outside of Wichita.

Aviv unfolds a tale of a man who began as a respected doctor and who took on Medicaid patients whom no one else wanted to see. At his clinic Schneider was courted daily by 12 or so different pharmaceutical companies which, he said, “enlightened” him about how to treat chronic pain with controlled substances such as Oxycodone (Oxycontin, Percocet) and Fentanyl (Actiq, Duragesic).  People who knew Schneider said he was "too trusting" and "laid back" and "saw himself as a rescuer, a savior of the downtrodden."

Aviv's article reveals how a lethal cocktail of Big Pharma marketing tactics, drug savvy patients who knew how to get drugs to fuel their addiction or to sell the drugs they obtained, a gullible doctor who ignored the warning signs of drug addiction and drug diversion tactics, an inept licensed practical nurse (Schneider's wife Linda) who managed the clinic, fraud and greed on the Schneiders' part, the federal government's inability to crack down effectively on drug misuse and abuse, a state medical board that insufficiently investigated Schneider’s clinic, medical peers who looked the other way, and the lack of education of doctors about opioids, resulted in so many deaths that have impacted and continues to impact so many lives.

Aviv also points out that opioids have become the “default solution,” particularly in poor, rural areas where few chronic pain specialists exist, for treating a “complex nature of physical and emotional distress.” Schneider acknowledged to Aviv that most of his chronic pain patients were probably bipolar and that he was "not diligent enough in digging into the mental part of it.”

In 2007, Schneider and his wife were arrested and charged with the unlawful distribution of controlled substances that caused the deaths of several patients. The indictment had linked their clinic with the deaths of 68 patients. In 2010, Schneider and his wife were subsequently found guilty by a jury for the unlawful distribution of controlled substances directly contributing to the deaths of a number of patients [as well as for health care fraud, money laundering, Medicaid fraud, and insurance fraud, and conspiracy (by Linda Schneider)] and sentenced to federal prison for 30 years and 33 years, respectively.

According to Aviv, the Schneiders want to become missionaries when they get out of prison, which, according to a psychic who advised Linda, would occur in early 2014. Schneider told Aviv that he missed the "positive feedback" from his patients and the gratifying experience of helping his patients alleviate their pain, but he now realized that he "probably needed them more than they needed [him]."