Opiates, Up Close and Personal

Opiates, Up Close and Personal

Robert Rassp By Robert G. Rassp, Esq.

I lost a friend recently. He had an “accidental” overdose of fentanyl. He was 53 years old. He graduated with honors from Harvard Medical School and became a skilled plastic surgeon with a fellowship in hand surgery. He taught me about hands, elbows and CRPS, and I taught him how to write medical legal reports in workers’ compensation cases.

He cared about his patients more than any other physician I have ever met. He spent time with them and he restored their functioning, even after a prior physician screwed up. He was only happy while he was in the operating theater.

He remains the hero of many patients who without his intervention would not have gotten better. I remember one client in particular who was 22 years old when she had to have her elbows and wrists re-operated because of failed prior surgeries from a less than stellar workers’ compensation doctor. She worked for a bank while a college student, and she overused her hands and arms. Thanks to my friend’s skill and caring, she eventually became a CPA. His medical practice consisted of only about 10% workers’ compensation patients. He was a real doctor.

Despite his skills and education, my friend became a substance abuser. When the California Medical Board threatened to discipline him, he agreed to stop drinking alcohol, which was originally his drug of choice. But people who abuse drugs and alcohol are resourceful. He eventually switched to fentanyl. The lollypops. The patches. The injectables. He could write a prescription for anything.

The National Institute on Drug Abuse (NIDA, http://www.drugabuse.gov/) classifies fentanyl as a drug of abuse:

Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates. It is a schedule II prescription drug.

In its prescription form, fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation.

My friend denied having a drug problem, despite some bizarre incidents my wife and I knew about or saw for ourselves. I stopped referring patients to him when I found out about his addiction. I think everyone else did too.

Opiate dependency and addiction are a national problem. Do you know how much a 90-day supply of Vicodin costs for four 750 ES tablets per day? Less than $250.00 - a very cheap way to manage pain from an economic standpoint. Generally, anyone who has to take over 4 tablets a day of an opiate has a problem with potential addiction and dependency.

We all know someone who is a substance abuser – a relative, a friend, a colleague, a client, you. I recently sent a client to Arizona for a 45-day opiate detox program – after two failed neck fusion surgeries, a frustrated treating physician who caused his addiction and a new baby on his way. So far, so good, but my client remains vulnerable like my dead plastic surgeon friend was.

If you know someone who is a substance abuser, do something about it. With my friend, we tried, but it was too late. After all, his death was an “accident.” Medical treatment for substance abuse is difficult and problematic. The substance that is being abused, i.e., alcohol, opioids, tranquilizers, and such masks some kind of physical or psychic pain a person is experiencing. But the substance does not cure the underlying problem that caused the need for the substance. That is the heart of the problem. Recent research is focusing on the craving people have for these substances along with cognitive behavioral therapies to address the underlying reasons behind an addiction.

Did you know that drug addicts will more often tell the truth about their personal lives and drug use to a computer rather than to a living person? Researchers are exploring that avenue for treatment approaches. Can you imagine your smart phone calling you and telling you to stop smoking, drinking and taking drugs of abuse? It is only a matter of time.

It is time for us to realize the impact opiate addiction and dependency is having on our clients, loved ones and colleagues. Hopefully you can discuss this case with your friends, clients and loved ones. This is not a legal problem, but it has become a societal one. This one is up close and personal, and I hope this message to you helps save a life before it is too late, even by “accident.”

© Copyright 2012 Robert G. Rassp, Esq. All rights reserved. Reprinted with permission.

Read The Rassp Report, a law blog by Robert G. Rassp, Esq.

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