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Here's the first page of the article: Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with a white Santa Claus beard, white hair and a calm, direct and intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver (pronounced mi-KEE-ver) has not been convicted of drug trafficking in the classic sense. He is a doctor who for years treated patients suffering from chronic pain. At the Pain Therapy Center, his small storefront office not far from Main Street in Greenwood, S.C., he cracked backs, gave trigger-point injections and put patients through physical therapy. He administered ultrasound and gravity-inversion therapy and devised exercise regimens. And he wrote prescriptions for high doses of opioid drugs like OxyContin.
McIver was a particularly aggressive pain doctor. Pain can be measured only by how patients say they feel: on a scale from 0 to 10, a report of 0 signifies the absence of pain; 10 is unbearable pain. Many pain doctors will try to reduce a patient’s pain to the level of 5. McIver tried for a 2. He prescribed more, and sooner, than most doctors.
Some of his patients sold their pills. Some abused them. One man, Larry Shealy, died with high doses of opioids that McIver had prescribed him in his bloodstream. In April 2005, McIver was convicted in federal court of one count of conspiracy to distribute controlled substances and eight counts of distribution. (He was also acquitted of six counts of distribution.) The jury also found that Shealy was killed by the drugs McIver prescribed. McIver is serving concurrent sentences of 20 years for distribution and 30 years for dispensing drugs that resulted in Shealy’s death. His appeals to the U.S. Court of Appeals for the Fourth Circuit and the Supreme Court were rejected.
McIver’s case is not simply the story of a narcotics conviction. It has enormous relevance to the lives of the one in five adult Americans who, according to a 2005 survey by Stanford University Medical Center, ABC News and USA Today, reported they suffered from chronic pain — pain lasting for several months or longer. According to a 2003 study in The Journal of the American Medical Association, pain costs American workers more than $61 billion a year in lost productive time — and that doesn’t include medical bills.
Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide. There are, of course, many ways to treat pain: some pain sufferers respond well to surgery, physical therapy, ultrasound, acupuncture, trigger-point injections, meditation or over-the-counter painkillers like Advil (ibuprofen) or Tylenol (acetaminophen). But for many people in severe chronic pain, an opioid (an opiumlike compound) like OxyContin, Dilaudid, Vicodin, Percocet, oxycodone, methadone or morphine is the only thing that allows them to get out of bed. Yet most doctors prescribe opioids conservatively, and many patients and their families are just as cautious as their doctors. Men, especially, will simply tough it out, reasoning that pain is better than addiction. Video More Video »
It’s a false choice. Virtually everyone who takes opioids will become physically dependent on them, which means that withdrawal symptoms like nausea and sweats can occur if usage ends abruptly. But tapering off gradually allows most people to avoid those symptoms, and physical dependence is not the same thing as addiction. Addiction — which is defined by cravings, loss of control and a psychological compulsion to take a drug even when it is harmful — occurs in patients with a predisposition (biological or otherwise) to become addicted. At the very least, these include just below 10 percent of Americans, the number estimated by the United States Department of Health and Human Services to have active substance-abuse problems. Even a predisposition to addiction, however, doesn’t mean a patient will become addicted to opioids. Vast numbers do not. Pain patients without prior abuse problems most likely run little risk. “Someone who has never abused alcohol or other drugs would be extremely unlikely to become addicted to opioid pain medicines, particularly if he or she is older,” says Russell K. Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York and a leading authority on the treatment of pain.
The other popular misconception is that a high dose of opioids is always a dangerous dose. Even many doctors assume it; but they are nonetheless incorrect. It is true that high doses can cause respiratory failure in people who are not already taking the drugs. But that same high dose will not cause respiratory failure in someone whose drug levels have been increased gradually over time, a process called titration. For individuals who are properly titrated and monitored, there is no ceiling on opioid dosage. In this sense, high-dose prescription opioids can be safer than taking high doses of aspirin, Tylenol or Advil, which cause organ damage in high doses, regardless of how those doses are administered. (Every year, an estimated 5,000 to 6,000 Americans die from gastrointestinal bleeding associated with drugs like ibuprofen or aspirin, according to a paper published in The American Journal of Gastroenterology.)
Still, doctors who put patients on long-term high-dose opioids must be very careful. They must monitor the patients often to ensure that the drugs are being used correctly and that side effects like constipation and mental cloudiness are not too severe. Doctors should also not automatically assume that if small doses aren’t working, that high doses will — opioids don’t help everyone. And research indicates that in some cases, high doses of opioids can lose their effectiveness and that some patients are better off if they take drug “holidays” or alternate between different medicines. Pain doctors also concede that more studies are needed to determine the safety of long-term opioid use.
But with careful treatment, many patients whose opioid levels are increased gradually can function well on high doses for years. “Dose alone says nothing about proper medical practice,” Portenoy says. “Very few patients require doses that exceed even 200 milligrams of OxyContin on a daily basis. Having said this, pain specialists are very familiar with a subpopulation of patients who require higher doses to gain effect. I myself have several patients who take more than 1,000 milligrams of OxyContin or its equivalent every day. One is a high-functioning executive who is pain-free most of the time, and the others have a level of pain control that allows a reasonable quality of life.”
Great article! Thanks for sharing it, Stacy. I get so frustrated that in this decade that is supposed to be focusing on helping chronic pain patients, the feds seem, instead, to be putting more energy into prosecuting doctors who are trying to aggressively treat pain.
Here's the first page of the article: Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with a white Santa Claus beard, white hair and a calm, direct and intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver (pronounced mi-KEE-ver) has not been convicted of drug trafficking in the classic sense. He is a doctor who for years treated patients suffering from chronic pain. At the Pain Therapy Center, his small storefront office not far from Main Street in Greenwood, S.C., he cracked backs, gave trigger-point injections and put patients through physical therapy. He administered ultrasound and gravity-inversion therapy and devised exercise regimens. And he wrote prescriptions for high doses of opioid drugs like OxyContin.
McIver was a particularly aggressive pain doctor. Pain can be measured only by how patients say they feel: on a scale from 0 to 10, a report of 0 signifies the absence of pain; 10 is unbearable pain. Many pain doctors will try to reduce a patient’s pain to the level of 5. McIver tried for a 2. He prescribed more, and sooner, than most doctors.
Some of his patients sold their pills. Some abused them. One man, Larry Shealy, died with high doses of opioids that McIver had prescribed him in his bloodstream. In April 2005, McIver was convicted in federal court of one count of conspiracy to distribute controlled substances and eight counts of distribution. (He was also acquitted of six counts of distribution.) The jury also found that Shealy was killed by the drugs McIver prescribed. McIver is serving concurrent sentences of 20 years for distribution and 30 years for dispensing drugs that resulted in Shealy’s death. His appeals to the U.S. Court of Appeals for the Fourth Circuit and the Supreme Court were rejected.
McIver’s case is not simply the story of a narcotics conviction. It has enormous relevance to the lives of the one in five adult Americans who, according to a 2005 survey by Stanford University Medical Center, ABC News and USA Today, reported they suffered from chronic pain — pain lasting for several months or longer. According to a 2003 study in The Journal of the American Medical Association, pain costs American workers more than $61 billion a year in lost productive time — and that doesn’t include medical bills.
Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide. There are, of course, many ways to treat pain: some pain sufferers respond well to surgery, physical therapy, ultrasound, acupuncture, trigger-point injections, meditation or over-the-counter painkillers like Advil (ibuprofen) or Tylenol (acetaminophen). But for many people in severe chronic pain, an opioid (an opiumlike compound) like OxyContin, Dilaudid, Vicodin, Percocet, oxycodone, methadone or morphine is the only thing that allows them to get out of bed. Yet most doctors prescribe opioids conservatively, and many patients and their families are just as cautious as their doctors. Men, especially, will simply tough it out, reasoning that pain is better than addiction. Video More Video »
It’s a false choice. Virtually everyone who takes opioids will become physically dependent on them, which means that withdrawal symptoms like nausea and sweats can occur if usage ends abruptly. But tapering off gradually allows most people to avoid those symptoms, and physical dependence is not the same thing as addiction. Addiction — which is defined by cravings, loss of control and a psychological compulsion to take a drug even when it is harmful — occurs in patients with a predisposition (biological or otherwise) to become addicted. At the very least, these include just below 10 percent of Americans, the number estimated by the United States Department of Health and Human Services to have active substance-abuse problems. Even a predisposition to addiction, however, doesn’t mean a patient will become addicted to opioids. Vast numbers do not. Pain patients without prior abuse problems most likely run little risk. “Someone who has never abused alcohol or other drugs would be extremely unlikely to become addicted to opioid pain medicines, particularly if he or she is older,” says Russell K. Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York and a leading authority on the treatment of pain.
The other popular misconception is that a high dose of opioids is always a dangerous dose. Even many doctors assume it; but they are nonetheless incorrect. It is true that high doses can cause respiratory failure in people who are not already taking the drugs. But that same high dose will not cause respiratory failure in someone whose drug levels have been increased gradually over time, a process called titration. For individuals who are properly titrated and monitored, there is no ceiling on opioid dosage. In this sense, high-dose prescription opioids can be safer than taking high doses of aspirin, Tylenol or Advil, which cause organ damage in high doses, regardless of how those doses are administered. (Every year, an estimated 5,000 to 6,000 Americans die from gastrointestinal bleeding associated with drugs like ibuprofen or aspirin, according to a paper published in The American Journal of Gastroenterology.)
Still, doctors who put patients on long-term high-dose opioids must be very careful. They must monitor the patients often to ensure that the drugs are being used correctly and that side effects like constipation and mental cloudiness are not too severe. Doctors should also not automatically assume that if small doses aren’t working, that high doses will — opioids don’t help everyone. And research indicates that in some cases, high doses of opioids can lose their effectiveness and that some patients are better off if they take drug “holidays” or alternate between different medicines. Pain doctors also concede that more studies are needed to determine the safety of long-term opioid use.
But with careful treatment, many patients whose opioid levels are increased gradually can function well on high doses for years. “Dose alone says nothing about proper medical practice,” Portenoy says. “Very few patients require doses that exceed even 200 milligrams of OxyContin on a daily basis. Having said this, pain specialists are very familiar with a subpopulation of patients who require higher doses to gain effect. I myself have several patients who take more than 1,000 milligrams of OxyContin or its equivalent every day. One is a high-functioning executive who is pain-free most of the time, and the others have a level of pain control that allows a reasonable quality of life.”
I,m pleased to see someone else to see someone else is sharing this article. My observations have shown me that the more we understand others, (especially those we depend on for help) the easier it makes our journey. Thankfully N Y TIMES is not routine Sunday reading for the christian right, I could see all of those "SATIN-serving drug pushers" going to prison! As far as the (so-called) chronic pain sufferers, all would be "escorted" to a safe place. We'd be shown the truth!! Our pain is caused by SATIN'S presence in our souls, perpetuated by, promises of relief through (false idols, discuised) narcotics, All we need is prayer, for forgivness, just like those ex-gays! Seriously, it explains a lot, and something needs to be done before all Drs. are afraid of (or are stopped from) treating us.chronic pain
Posts: 8 | Location: St. Louis MO | Registered: 07-30-2007
Thank you stacy for providing us with this very interesting article.
I'm not certain, but I part of me feels like this kind doctor should of been a little more careful, but not knowing who or what his patients were struggling with pain illnesses, it's very hard to tell. I'm surprised, but this article also included some very rational and great points on the hazards of the undertreatment of pain on many of us who suffer. I really can personally tell by my own bodyily funcitions that when my own pain is ramping to high levels, that my heart rate goes up and I can even feel that my blood presure is high if someone where to take it. I experienced this last evening after coming home from church. For some awful reason, every time I attend church, my pain levels are triggered by the car ride and also the pews. I really have to try and keep going, as the time spent in prayer and with the lord are definately one of my coping mechanisms that help me to keep a clearer head and also bring peace to a stressful situation. weighing the alternative and making the decision to go have been somewhat distressing. I have been forced on occaision to ask for our parish home ministry service wher father visits me at home.
Thank you for sharing this very well written article Betty
"Only by openness to the mystery of God, who is love, can our hearts' thirst for truth and happiness be satisfied; only the perspective of eternity can give authentic value to historical events and above all to the mystery of human frailty, suffering and death."
Pope Benedict XVI
Posts: 515 | Location: Home in Washington State | Registered: 11-07-2007
Hi, I have been going back over some of these posts and I wanted to make a reply to bring this topic back to the forefront in hopes it would help or be of interest to some of our newer pain members. So this post is just a test to see if my reply will bring it back to attention to some new comers to read.
Thanks Betty
"Only by openness to the mystery of God, who is love, can our hearts' thirst for truth and happiness be satisfied; only the perspective of eternity can give authentic value to historical events and above all to the mystery of human frailty, suffering and death."
Pope Benedict XVI
Posts: 515 | Location: Home in Washington State | Registered: 11-07-2007
Yes I have had trouble too. I am receiving pain management from outside source. I am happy with it but I have to refill every two weeks and that does not help with what I would like to do one day (mission work) outside the states. I am very concerned the new phychiatrist just yelled at me because I have a pain pump and took me off of clonazepam (treats Ptsd,TBI, seizures and I have been on it for 4 years and she said immediately I needed to detox. I was offended. I had a sleep study that morning EEG and I was confused and accidently took an EKG as well. I was under tremendous stress and my pulse was slow and my heart had skip beats. I don't overtake my meds ever. She apparently has not studied my condition and knows nothing about seizures, or TBI patients.
I have searched the net and I can't find any drug interactions I am on 2000 mg of Keppra, 3 mg of Clonazepam and dilaudid pump. Before I had this drug combination I could not even sit here and participate. last time I went to VA Chronic pain they left me in bed for a year in agony I could only sit up for maybe 15 min on a good day. I have lack of blood flow and oxygen to the gross frontal lobe and I broke C1x3 and it grew displaced. I need help I don't want to go through all the different drugs again that I went through before. she is saying no benzodiazapines at all and I have very severe spaticity even with the clonazepam. In fact I had some left from last month and she was very accusing saying I needed to go into drug detox. I just paid 10,000 for this pump and it makes life easier but I still am not able to fight well I need help I am still in pain, exhausted but praise the Lord I have hope. Just when I thought I had a network of Doctors it go away. also She accused me before she found out about the slow pulse but I don't believe it is the drugs. I don't know who to talk to many times I'm not sure I will wake up I believe it is neuro matter but I don't know how to prove it that is because the brain has been acting up ever since the TBI I was unconcious a long time and I have gone into several coma's since then before the pump what do I do
I had always thought that as long as there was an actual diagnosis which was proven by tests, MRIs, etc.that there usually wasn't a problem for doctor or patient. In fact, working as an inmate counselor at a mens high security prison, I never saw any physicians who were convicted of this type of charge, unless they kept either poorly documented records or none at all, and/or purchased an exorbitant amount of meds, or prescribed them to false patients.
I'm certain these cases do happen, but as in any occupation, documentation is always the best and safest route to take. My doc told his assistant who refills meds that I take a lot of narcotics and she just needed to deal with it. I have been on pretty heavy duty meds for many years and the only medication I had trouble refilling was my Zoloft-the antidepressant. No just how much sense does that make.
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