Doctors who say no to opioid use face threats

One patient threatened to shoot Dr. Terry Hunt if physical therapy didn't relieve his pain as effectively as opioids did. Another harassed his staff, then roamed a hospital searching for Hunt after being told he would be weaned off painkillers he had used inappropriately.

Hunt was unharmed, but shaken enough to ask the central Illinois hospital system where he worked to dismiss both patients.

So when he heard a bout Tuesday's attack at a medical clinic in Buffalo, Minnesota, that left one person dead and four injured ,“the first thing I assumed is that it was something to do with pain medication,” said Hunt, who now works for the Mayo Clinic in Rochester, Minnesota, and a Mayo Clinic Health System facility in Red Wing, Minnesota. “It makes us ask about our own workplace: How secure are we?”

Authorities said Gregory Paul Ulrich, 67, was angry about his medical treatment before he shot five workers and detonated three apparent pipe bombs at an Allina Health clinic. A police report says he had threatened a similar mass shooting in 2018, allegedly as revenge against people who he said “tortured” him with back surgeries and prescribed medication.

A former roommate said Ulrich became upset when a doctor stopped prescribing painkillers, and that Ulrich also used other drugs and had untreated mental health issues. Law enforcement and the health system have not addressed the spec ifi cs of Ulrich's treatment or medications.

Doctors who treat pain say threats of violence escalated markedly in recent years as mounting legal and regulatory pressure stemming from the deadly opioid epidemic led many to prescribe alternatives and taper their patients off addictive painkillers.

While some patients benefit from careful use of opioids, and doctors don't want to stigmatize them, many would be better off treating pain with other therapies, experts say. But many become addicted to the drugs that are often intended for short-term use following surgeries.

“It hijacks their brain,” said Dr. Carrie DeLone, regional medical director at Penn State Health Community Medical Group. “They don't see themselves as having a problem.”

Pain specialist Dr. Andrew Kolodny,a professor at Brandeis University and a founder of Physicians for Responsible Opioid Prescribing, said patients are convinced t hat opioids are treating their underlying problem because if they try to go without a dose or as their previous dose wears off, “they're feeling horrible, agonizing pain,” when it can be the withdrawal that is causing pain hypersensitivity.

“It's much easier to give the patient what they want. You write the prescription ... they walk out the door happy and there are no problems. To try and help a patient taper down ... is much harder,” Kolodny said.

And when a doctor says no, things can turn ugly.

“We've had patients waiting for doctors in parking lots to harass them. We've had them say ` We're going to shoot you' or `We're going to burn your house down,'” DeLone said.