It might be ok to point the finger at the doctor who treats a celebrity or a person that is so blatantly addicted to drugs, (I also think that people who engage in drug seeking behavior ALSO need to be held accountable for their behavior, let’s not let them off the hook that easily). But what about those addicts that go “dr shopping?” of course they aren’t going to admit that they are an addict. They are specifically going around from doctor to doctor in order to get controlled substances. The doctor doesn’t know they are addicted to opiates (or whatever their controlled substance of choice is). If they happen to overdose should the doctor be held responsible? especially if the patient didn’t let the doctor know they have a history of abuse. It’s really hard to say who should be to blame.

I believe that doctors who write scripts for opiates, benzos or other meds with high potential for abuse should thoroughly screen the patient for substance abuse before writing the scrip. Even then, the doctor should probably not not write a long-term, refillable scrip on the first visit. I know one doctor who writes short term scrips and if the patient returns for follow up care and tests confirm the patient’s source of pain, the doctor then writes a prescription for longer term or refills. The simple solution for doctor shopping crisis is a nationwide database that tracks prescriptions, along with stiff punishment for doctors who recklessly prescribe these drugs. Michael Laforgia, my colleague at The Palm Beach Post, wrote a story on the pill mill pandemic in south Florida and the doctors behind the scrips. You can find it here… http://bit.ly/3Cj8KI

Like the above commenter said I really think BOTH parties need to be held accountable. A good friend of mine is on long term opiate care for fibromyalgia. Unfortunately many kinds of pain can not be found on an xray…chronic back pain for example. Some addicts take advantage of that. If someone goes to a pain management clinic with “chronic back pain” and gets a script for vicodin or something they can keep going back to the same doctor getting prescription after prescription claiming their pain never went away. I’m not saying it’s right, but all I am saying is their really is no easy way. A database that tracks prescriptions is a good idea to see if the person bounces from doctor to doctor. But if one person goes to the same doctor month after month it’s really not going to help. Doctors do require random drug testing if they have patients on these meds long term.

You are absolutely correct that the only way that we are going to stop more and more people from dying of prescription drugs is to start prosecuting the drug company execs who put these drugs out for “off-label uses and the doctors who are only drug dealers.

At Novus Medical Detox Center we daily deal with people whose lives have been ruined by these prescription drugs.

We have to stop them and I am all in favor of sending them to jail. Maybe that will stop some of this reckless behavior.

Steve
http://novusdetox.com

In Smith’s case, the fault was shared by both involved parties. Of course, Anna was wrong for abusing the drugs in the first place; however, the doctors clearly knew she was an addict (the whole country did), yet continued to write her prescriptions. More so, from what I understand after reading your blog, they even committed forgery. I would say the blame is divided in Michael Jackson’s case, as well: MJ was at fault for abusing the drugs, but that doctor should never have put him under as a “treatment” for insomnia.

Saying that, in the majority of cases I honestly don’t think the doctors deserve a lot of blame. Sure, there are far too many that abuse their license or over-prescribe certain medications; however, many do the best they can with the information available to them. Doctors are regular human beings, not mind readers or masters at spotting drug/alcohol-abusing patients.

As somebody who has seen multiple family members grapple with addiction, I know that addicts/alcoholics are masters at manipulating others. To get the high their minds crave, they will fake symptoms perfectly, lie completely about drug or alcohol abuse and, if they fail at one place, go right on to the next until they find someone who will believe them. Add that to the fact most doctors don’t have a lot of time to spend talking with the patients they see (thanks to our insurance companies) and you have a very toxic situation.

Of course, the alternative is to have doctors only prescribe medication when there is unquestionable proof of a condition; however, this would only leave people suffering. As someone else here mentioned, there are some things you just can’t test for. Pain and anxiety disorders are two great examples. Instead, these doctors have to take their patients’ word when they come begging for symptom relief.

Do you want to know what else can’t be medically tested for? Addiction, alcoholism and any other psychiatric disorders that could potentially coexist can’t. So, if somebody swears that they don’t drink heavily/drug and there is no revealing evidence to suggest they are lying (say, a drug-related felony conviction), then there is nothing a doctor can do but take their word.

With Love,
Erika

I have been clean and sober since 9-9-08; I detoxed off Vicodin, Alcohol and Klonopin. Trust me it wasn’t fun! All my doctors know what my meds are and my past issues with addiction. Yet I have a current script for Vicodin (for foot pain); Fiorocet(for migrane) Midren(migrane) and Klonopin(for anxiety); Plus amitriptyline for an antideppresant and pain management. I have the thoughts to take them together, yet my doctors think I can handle them OK- until I can’t. I am working hard to stay clean so I can get my son back, he, not the doctors is the one keeping me on the straight and narrow.

Many, many times doctors have prescribed pain pills, muscle relaxants, sleeping pills or anti-anxiety drugs to me for broken bones, pulled teeth, childbirth and major surgery.

Never has a doctor asked me if I am an addict/alcoholic or if I have any kind of history of substance abuse. Has your doctor or dentist asked you – much less screened you for substance abuse – before handing you a prescription for these drugs?

The same thing happens when doctors/nurses prescribe medications for depression, anxiety or other mental illnesses. If you are on these drugs, did your doctor/nurse ask about substance abuse before giving you a prescription for Xanax?

Everyone knows that we are brilliant liars, which is the reason why doctors must probe deeper than “Are you an alcoholic or drug addict?” on a form. Off the top of my head I can come up with a few questions that I would ask before writing one of these scripts.

1. When was the last time you had a drink?
2. How often do you drink?
3. When was the last time you had a hangover?
4. Have you ever been arrested or charged with a crime involving drugs or alcohol?
5. How often to you smoke marijuana or use drugs not prescribed to you or for their intended use?
6. How many people in your family have had/do have a substance abuse or alcohol problem?
7. When you do not feel well or are in pain, what do you do?

The doctors should ask questions that require an explanation rather than “yes” or “no”. The questions should be asked and answered verbally, not on a form. It is easier – even for us alcoholics and addicts – to lie on paper than in person.

I completely agree that addicts and alcoholics bear some responsibility. However, to say that Michael Jackson was at fault for abusing the drugs is a misunderstanding of the disease. It is like saying that Michael Jackson is at fault for having a disease that wipes out his ability to control his drug use.

We cannot control our drinking our drug use. That is why we abuse drugs and alcohol. Our brains react differently to these substances than healthy brains. We are sick. We need doctors to ask more questions if we are going to get better.

Christine,

I do agree doctors should ask these questions. At the same time, the patient also holds some responsibility to inform a doctor of their history with addiction. To add onto this, a friend of my father is addicted to pain pills and alcohol. This friend goes to countless different doctors for his next legal hit. One of these doctors asked him about his alcohol usage and he lied about it. In that case, is it still the doctor’s fault for not “screening correctly”?

“However, to say that Michael Jackson was at fault for abusing the drugs is a misunderstanding of the disease. It is like saying that Michael Jackson is at fault for having a disease that wipes out his ability to control his drug use.”

I know addiction/alcoholism is a disease. I have seen the devastation that comes with it. At the same time, he is still at fault for using. Why? Because, even though those cravings are almost unbearable, it is still the choice of the person to pick up that drink/drug. Disagree? Just listen for a second.

Nobody is forcing the person to get their next high. Not even the disease of addiction is forcing it. What addiction will do is attempt to get the person to minimize the significance of or rationalize the usage. The addict, however, still has the ability to fight that craving. Sure, winning will be painful, difficult and flat out exhausting; yet, it is far from impossible. That will and strength to fight that craving is the reason so many are clean/sober. If addiction really did have all the power, it would be impossible to treat. Its victims would just be stuck drinking/using with no hope for sobriety.

Thank about it. An addict can have all the support, steps and clean/sober time behind them as possible BUT it is still their responsibility not to drink/drug. If they relapse, it is THEIR fault. You CHOOSE not to drink, but you also have the power to CHOOSE to go back into it.

Addicts are responsible for their usage.
They are responsible for the stupid things they say and do while high/drunk.
They are responsible for the damage done to themselves and family.
They are responsible for getting the help they need.

I don’t say any of this out of ignorance. Trust me, I know it can be an extremely hard fight at times. But even father – a severe crack addict – agrees with this point. To quote,

“Addicts do have control over that first usage. It’s only after that do we loose control.”

Thank about it
should me *Think about it

I absolutely agree that addicts/alcholics are responsible for their usage; stupid things they do and say while drunk/high; damage done to themselves and other; and for getting the help they need.

As for Michael, I do not know how or what the doctor asked him. Like I said in my earlier post, it makes little sense to ask “Are you an alcoholic?” or “Are you an addict?” That is NOT screening a patient for substance abuse. I do not know how deeply Michael’s doctor probed. I DO know that a proper screening protocol can enable the doctor see through the lies. However, the doctor has to WANT to find out. Just tossing a few questions out there is not enough. If the doctor even suspects substance abuse, she can require a drug test.

My experience with my own alcoholism/addiction is that there are three elements:
Craving: a strong compulsion to use.
Loss of control: inability to stop once I have begun.
Physical dependence: withdrawal symptoms. Without the drink or drug I will become sick, or even die.

I have been clean and sober for over 11 years. But some of us are sicker than others. I believe that for some addicts/alcoholics, their illnesses are so advanced and the physical dependence is so strong that they truly are incapable of stopping unless physically prevented from doing so. In other words, they WILL drink or drug until they die. They know that but cannot stop themselves. They need the help. They cannot do it on their own.

You are right. It is the first drink that gets us drunk. But for some, the physical dependence and withdrawal symptoms are so advanced that they cannot prevent themselves from taking the first drink.

Christine,

In Micheal’s case his doctor does hold a lot of fault. More so because of the anesthetic used to “treat” his insomnia than anything else. Agreeing to put him under like that one doctor did is not only highly illegal, but also terribly irresponsible. I was so taken aback when I heard about it that I don’t think I could put it into words. Using a state of anesthesia to get somebody to sleep is such an abuse of practice. Of course, that is all made worse when you take into account the cocktail of other prescriptions he was taking. All of which, of course, were legally bought, even though his battles with drug addiction were in the public eye.

Thankfully, these “celebrity doctors” are not the majority. Most do try their hardest to “do no harm” and really have the best intentions. Unfortunately, all the questions and urine tests – which can be easily tricked to produce a negative result – in the world will not always guarantee detection of addicts/alcoholics. You mention suspicion, but many users will not say or do anything to alarm a doctor. While I do not argue that our doctors can do better, there are still times where there is nothing they can do.

So, the addiction continues and those three things you mention feed off each other (usage leads to dependence, which leads to cravings, the craving leads to more usage, which leads to lack of control, which leads to more usage, which leads to more severe dependence, which leads to stronger cravings, which leads to more usage, etc, etc). You mention that some are so severe you have to physically take the drug away from them and prevent access. While many will disagree, I think that if a person becomes a danger to himself/others, that method should be forcefully used. For the person and their family’s sake.

You are right about some being sicker than others. Even in my own family, there have been multiple different degrees of severity. Some have been able to sober up first try and others have remained stuck in the cycle of addiction. My father is, sadly, one of the latter. He’s lost his job, home, family, wife, finical stability and the opportunity to live a happy life. Still, whenever he can afford it, that rush from crack cocaine (or pot or beer) is at the top of his priorities.

At the same time, I don’t think anybody is to far gone to be saved. If people have successfully sobered up at seventy after years of drinking/using, then – with A LOT of work – anybody can.

With Love,
Erika

Please don’t act is if the rest of us would get comparable medical treatment as Anna Nicole Smith and Michael Jackson. Writing articles that compare celebrities with the general mental health community does not provide a good illustration of reality.

Once I had a 3 day severe anxiety/panic attack and the ER physician would not even prescribe me 1 milligram of Ativan. I left the hospital and drank a bottle of wine to supress my CNS, which only worked for a few hours. I was not a substance abuser, but my other choice at that time was losing my mind. Finally, a general practioner came to her senses and prescribed me some xanax to last me until my psychiatrist appointment I had already scheduled, but had to wait weeks for. That was day 4.

You could not imagine what it is like to be awake for 4 days straight with severe anxiety, but when you go to seek help, doctors would rather let you lose your mind than prescribe one of those evil addictive pills that are abused by those who don’t have mental health problems. It was a traumatic experience, and to this day, I could never again go to an ER for a mental health crisis.