By CRAIG MURPHY
Of the Keizertimes
The numbers are staggering.
Dr. Jay Jamieson has faith things will get better.
According to the Centers for Disease Control and Prevention (CDC) National Vital Statistics System mortality data, 44 people die each day in the United States as a result of prescription opioid overdose.
The data shows there were 43,982 drug overdose deaths in this country in 2013. Of those, 51.8 percent (22,767) were related to prescription drugs. Statistics show drug overdose to be the leading cause of injury death in the U.S. in 2013.
The numbers for 2014 were even worse, according to data posted in December in Morbidity and Mortality Weekly Report: 47,055 drug overdose deaths in the U.S. Rates of opioid overdose deaths increased 14 percent in the one year.
Opioids include drugs like heroin, which has been a key focus of the ongoing Chasing Dark series in the Keizertimes. Prescription opioids include hydrocodone (Vicodin), oxycodone (OxyContin), oxymorphone (Opana) and methadone, as well as benzodiazepine.
In the series of stories, several people interviewed pointed the finger at the medical community for prescribing opiate painkillers, an addiction studies have shown can easily lead to a heroin addiction. Jamieson, who has been a doctor for 36 years and came to Keizer Klinic – now known as WVP Keizer Clinic – in 1987, said fewer prescriptions are being given out by the medical community these days.
“A large amount of people in power are well aware of the problem now,” Jamieson said. “The number of deaths should be reduced in the upcoming years. It takes time to turn the ship around, but over the next five years we will start seeing a trend where those numbers go down.”
While in medical school and during his residency, Jamieson said caution was expressed in terms of prescribing opiates.
“When I started, our understanding of opiates was they are addicting,” he said. “They are to be used very carefully and sparingly. We were taught you need to get patients off that medication as soon as possible.”
By the time Jamieson came to Oregon to practice in 1983, it was made clear to doctors such as himself the Oregon Medical Board carefully monitored prescriptions, especially of narcotics.
“If there was over prescription, you would be called in before the board,” Jamieson said. “I understood it and most other doctors did as well.”
Jamieson said things changed in the 1990s when Purdue Pharma pushed the belief that its OxyContin product was not addictive.
“It was foisted upon the U.S. medical community, state by state, so that state medical boards started accepting it and penalized doctors for under prescribing,” Jamieson said. “We were told we had to be a pain manager, so we could use the products.”
Jamieson recalls coming back from training about pain management with co-worker Dr. Greg Thomas.
“We asked each other, ‘When did opiates become not addictive?’” Jamieson said. “We prescribed it, but not for a large number of people.”
By the 2000s, the tide started to turn and lawsuits started being filed against Purdue. In 2007, current and former company executives pleaded guilty to misleading the public about the risk of addiction of OxyContin. The company was hit with more than $600 million in fines.
Jamieson said in the last few years the pendulum has been swinging the other direction.
“The Oregon Medical Board is aware of what’s happening and they’re taking steps to get us back to the correct norm,” he said. “They are closely watching prescription habits. People do have pain we need to treat, but we have to be careful what road we’re taking them down.”
Jamieson said he has a handful of patients with chronic pain that he prescribes a modest amount of narcotics to. The dosage is closely monitored to make sure the use doesn’t become habitual or an addiction.
“We want to help, but we have to be careful,” Jamieson said. “We don’t want to hurt them but we also want to not get into trouble. I’ll prescribe a short-term narcotic, but for long-term I want something safer that’s non-addicting. My patients appreciate that.”
Jamieson said there are some who hop from doctor to doctor, seeking prescription opiates.
“The real problem is the drug seeker,” he said. “You don’t know if they’re addicted and just using me as the portal to a prescription, or turning around and selling it.”
Jamieson emphasized his clinic never bought into the push from Purdue.
“This clinic did not buy into the theory of opiates not being addictive,” he said. “We held out all along.”
Helping doctors across the state is a new registry system.
“If you get a narcotic from a doctor, within a day you’re on the list,” Jamieson said. “If I look you up and see you hit up five doctors up and down the I-5 corridor for a prescription, I’ll know about it. As doctors, we can all do this. We can look and see what’s going on.”
According to Jamieson, Salem Hospital’s announcement a few years ago of no longer refilling prescriptions for narcotics was helpful as well.
While the medical community as a whole has been paying closer attention to painkillers, Jamieson said patients can do their part as well.
“Families can help by being very careful,” Jamieson said. “If you had a prescription, make sure it’s locked and away from kids. When you’re done with them, there is a system where you can hand in used prescriptions. Get rid of them. That’s how kids get started, by finding them in medicine cabinets. They’re not thinking about the long-term consequences. You have to protect them.”
Jamieson said narcotics are used because when a patient has intense pain, there’s nothing quite like a narcotic. Tylenol can be used on the low-end of the pain spectrum, followed by anti-inflammatory relief like Aleve or Motrin, which can be used with a muscle relaxant for issues such as back pain. Then there is Tramadol before narcotics are used.
“With chronic pain, there are people who legitimately need a dose or two of a narcotic,” Jamieson said. “You have to make sure use is not accelerated. Most of the time we will have a pain contract. We sit down and talk about limits, I’m the only person to prescribe it, what the potential side effects and risk of using it are and that you only go to one pharmacy. If there’s any breakdown in that system, they are not your patient anymore.”
In one of the Chasing Dark stories from last fall, members of the Keizer Police Department’s Community Response Unit talked about how addictions to heroin often start.
“A lot of times it is an injury,” officer James Young said. “When people can’t get more (painkillers) from the doctor but they are hooked on the opiate, they turn to street level heroin. A lot of times it will be after an injury or just experimenting. Sometimes it is a familial connection. Sometimes you’ll see the drug use going on in your house growing up, so you wind up using it yourself.”
Sgt. Bob Trump noted the addiction to opiates at first seems harmless.
“It often comes from the doctor, so it’s seen as being safe,” Trump said. “Then (the prescription) dries up, but by now you are addicted.”
The KPD has a drug turn-in receptacle in the police department’s lobby for old prescriptions.
Jamieson believes doctors are now helping to turn the problem around.
“We got ourselves into trouble as the medical community,” he said. “We were misled by a large medical company. But the pendulum has been switched the other way. Systems now more closely monitor (opiate) usage. We are being encouraged to reduce the number of pills prescribed.”
This story is from the February 2016 Salem-Keizer Health and Wellness Magazine, which came in the Feb. 19 issue of the Keizertimes.