On Lent, Drugs, and Letting Go

I usually hesitate to write about things that could be deemed overly religious, because I am not overly religious. We didn’t join our left-wing liberal little church community for the “churchy” part, but rather, for the “community” part. Where else in your life can you choose your extended family? And have them actually be really cool?

So, this Lent thing. I remember being a school-aged kid at Catholic Sunday School, and we all needed to choose “something” to give up for Lent. Everyone gave up some candy or a TV show. That concept has stuck with me, and everyone else, I think, as many people I know gave up “things” like social media or carbs for Lent this year.

And me too. I announced that I was giving up chocolate, not as a Christian gesture, but more as a test of willpower. I’d become rather free-handed with the economy-sized bag of dark chocolate baking chips in the pantry…

But an experience in clinic recently made me sit and think about what Lent is. Seriously. See, we have this new program called the Prescription Monitoring Program, where we can (and are required) to look up and review the controlled substance prescription history of any patient for whom we are about to write a new controlled substance prescription.

Why? Well, we are in the midst of an opiate abuse epidemic, and it’s largely our fault. Yes, us, the prescribing doctors.

Our newspaper recently chronicled how the opiate addiction and drug trade has ruined several towns. Read the obituaries and peruse the young faces, kids who died “suddenly and unexpectedly”. Case in point, our nephew Christopher in October 2013… so, so tragic.  First responders now carry Narcan as a matter of course. On the very first day one nearby town implement this, police officers responded to a call of an unconscious man at the railroad tracks. His friend thought he’d been using heroin, the police used their brand-new Narcan, and, voila! Resurrection.

Loose and unregulated prescribing combined with powerfully addictive opioids and a steady stream of cheap heroin from abroad created this mess. Doctors were writing all kinds of pain medication prescriptions without knowing who was getting what from who else. This stuff hit the family medicine cabinets and then the streets and created dependence, as well as an illicit economy. When the addicted got priced out of the pills, they turned to heroin. And so on…

Many changes have been made even in the past six years that I’ve been an attending. We used to be able to call in a short supply of narcotics on the phone; hence, all weekend long, patients would call saying they’d lost their prescription, et cetera, and without easy access to the electronic record, there was no way to verify what was a true story. We all felt like we were being fleeced, but could never prove it. Now, there is no way to call in controlled substances, at all. Weekend call has improved significantly!

Back to the Prescription Monitoring Program (PMP). We all had to be verified as providers and issued a password to access the site first, so it took some time. I’ve only recently been able to log on and review my patients’ prescription history. But, since I have, I can now see every single controlled substance prescription for anyone, when and where it was filled, and who wrote for it. Hence, I’ve discovered a few cases of questionable, or even blatantly abusive, narcotics use.

Recently, I “caught someone out” on the PMP. They’d apparently gotten a bunch of pain meds through various other providers.* I got so angry. In my head: You were LYING to me! My first reaction was to feel betrayed and cheated.

But, for some reason, I let it be for awhile. In fretting about what to do, I let the anger part go, and tried to think more like a physician. I remembered our nephew: addiction is a medical and psychological disease that requires medical and psychological treatment. Lying is a part of the disease.

I’m not especially well-trained to manage addiction. So I reached out to a specialist, asked for advice. We put together a plan. The specialist gave me the language that I’ve used now several times: We believe that you have real pain, and we want to help you, using the safest and most effective treatments. We want to work with you, and this is what we have to do in order to be able to work together. Face to face with the patient, I was nervous as I reviewed the medication contract, as I asked for a urine for tox screen and drug profile. But it went okay.

Out of all of this, I was most proud of the fact that I didn’t act out of anger. I didn’t fire the patient. I let go of judgment and acted based on practicality. I’m not always able to do this. Our friend Steve, who passed away last week, really seemed to have this quality, this grace, that I’d like to aim for.

What does this have to do with Lent? Well, if Lent is about giving something up, I’d like to try to give up anger and judgment. Will that happen? Probably not completely. Hey, I’m human.  But it’s a hell of a lot more significant than chocolate.

*Not one particular case, but actually more than one, and details have been omitted or combined to protect privacy.