Opioid use akin to making deal with the devil
Dr. Jerry Martin: ‘Going through withdrawal from these medications can be absolute hell’
On the heels of a Drug Enforcement Administration database revealing that between 2006 to 2012 there were 324,690 opioid pain pills supplied to residents of Rappahannock County, retired longtime Washington Dr. Jerry Martin weighed in on the local and nationwide epidemic surrounding the drugs.
The database, first published by the Washington Post, tracks every opioid pill manufactured and distributed in the United States on a county-by-county basis. Nearly 100,000 deaths were reported nationwide during the seven-year time frame ending in 2012.
All told, more than 76 billion oxycodone and hydrocodone pills were distributed across the country in that period — 324,690 of them provided to Rappahannock County, a tiny fraction of the national distribution.
In fact, divided by the county’s population of 7,373 at the 2010 census, the opioid distribution in Rappahannock is fewer than 45 per person for the seven-year period tracked by the DEA.
The data for Rappahannock County also shows which pill manufacturers supplied the drugs and the pharmacists or doctors prescribing the most. Since Rappahannock County does not have a pharmacy, it is not surprising that the database shows Dr. Martin, who retired in December after 44 years in practice, received the most pills for a dispensary he maintained for his patients.
In a telephone interview with the Rappahannock News this past week, Dr. Martin described his experience with the “historical underpinnings” of opioid use.
“When I first started out in practice,” he said, “you had to be on death’s bed to get something like [opiates]. About the same time OxyContin came along there was a sea shift in the attitude toward chronic pain. In my practice there were a lot of people with chronic pain. It was a huge issue.”
Did he ever question the use of opioids for his patients?
“I start with the basic premise that the patient is telling me the truth when he says, ‘I have back pain.’ I do all the reasonable things that a doctor should do with that. A lot of times the x-rays look perfectly normal. I don’t give everybody a lie detector test — ‘Are you telling me the truth about your pain?’ Pain is a subjective experience,” he said. “If I didn’t trust the people coming in then that destroys the doctor-patient relationship.”
But he admitted that over the years, “it became obvious that more and more people were abusing these medications. [There] were some people that broke the doctor-patient relationship, they broke my trust.”
For the most part, he trusted the conventional wisdom of prescribing opioids for pain.
“So we’re happily going on our way and suddenly there’s a 180-degree shift [in thinking about opioids] and everybody who takes pain medication is [considered] a user, addict, selling medication on the street,” he said. “And some of the doctors say, ‘Oh, no, it’s going to look bad on me.’”
Dr. Martin described taking opioids as akin to “making a deal with the devil,” even for those patients who use them responsibly. “Going through withdrawal from these medications can be absolute hell. The dilemma for me when I decided to retire on behalf of these patients, as hard as I tried I was unable to find somebody who would come in and take over my practice.”
Essentially, he said, “There’s no easy fix [for the use of opioids for pain]. Not everybody has infinite resources. Not everybody has a choice.”