Painkillers: A prescription for trouble

By D. C. Moody dmoody@civitasmedia.com

March 18, 2014

PICKENS — While the movement for medical marijuana legalization is gaining momentum across the United States, the Pickens County community is instead struggling with a drug problem stemming from prescription medications.

Pickens County is ranked number one in the Palmetto State in deaths by unintentional overdose, 25 accidental overdoses having been reported in 2013 alone and while that is a disturbing statistic, Dr. James Mahanes, general surgeon with Cannon Memorial Hospital, found the numbers disturbing as well.

“In late 2009, here at Cannon, I became aware of the number of prescriptions being given out and the number of people referred to my office and was shocked,” Mahanes said. “As a physician I’m able to look up the prescriptions some referrals were receiving in a month, sometimes 120 to 240 pain pills in a month, and I knew there was a problem, especially when you’re being asked to do IV’s for pain medications. So I went to the medical staff with it hoping to make a change.”

Mahanes’ shock prompted the surgeon to act, helping initiate and form the Prescription Drug Abuse Alliance, originally an initiative with Cannon Memorial only, but since has seen Baptist Easley Hospital join.

“I took a look at what I think are the root causes as to why there are so many prescriptions written and I knew something had to be done,” Mahanes explained.

South Carolina ranks 23rd in the nation for the number of prescribed pills distributed on annual basis. Pickens County ranks number one in the state.

“When it comes to prescribing pain medication, there’s a lot of pressure brought to bear and not only by the people who are looking for prescriptions,” Mahanes explained. “There’s pressure on doctors to prescribe these medications from the federal and state levels as well. Regulations require that people’s pain be managed in an outpatient setting, it has to be controlled, and these regulations make it difficult.”

According to Mahanes, funding has a great deal to do with the issue at hand.

“There’s a lot of pressure when it comes to customer satisfaction surveys, which all hospitals participate in for funding,” said Mahanes. “Those surveys are tied to federal money and when the patient’s expectation of relief may be a big factor in how those surveys are answered, there’s pressure for the hospital and the physician.”

According to Mahanes, when it comes to managing pain the patient’s expectations and reality might not be one and the same.

“People in serious pain want and expect their pain levels to be a zero out of 10, when that may not be possible,” Mahanes went on to say. “Doctors want to help, but we can’t do it all and there’s a liability for the physician for either under-prescribing or over-prescribing based on the regulations in place. I try to help my patients by using other medications in conjunction, such as Tylenol or ice to help ease pain.”

The Prescription Drug Abuse Alliance, Mahanes’ brain-child, was designed to educate doctors locally on the statistics and results of the county’s prescribing practices. According to Mahanes, the three prescription pain medications at the root of so many of Pickens County’s deluge of prescriptions are oxycodone, hydrocodone, and injectable Demerol-type pain killers.

Has the Prescription Drug Abuse Alliance made in-roads?

“There has been some progress made, but the problem is an apathy within the community and it seems they don’t get the message yet,” Mahanes said. “People see an ad on TV, or get a prescription and the assumption is its safe. The alliance is trying to reach the community and help them have an understanding of what kind of problem prescription pain killers are.”

Mahanes also sees a change in the public’s perception as adding to the problem.

“There are high quantities of these pain killers being prescribed, and for someone on Medicaid for example, they may get 120 hydrocodone for $3 every month,” he said. “Patients who are in pain want them (pain medications) because it’s almost as if it has become a sense of entitlement, their pain has to be controlled and as a doctor they expect you to provide the medications.”

The Prescription Drug Abuse Alliance will meet March 17 at J Peters in Seneca beginning at 6:30 p.m. for local physicians to discuss ideas in an open forum, including the statistics associated with Pickens County’s prescription numbers addressed specifically, though the problem isn’t unique to Upstate South Carolina.

“The United States makes up approximately 4.6 percent of the world’s population, to put it in perspective,” Mahanes said. “As a nation we consume 80 percent of the opioids and 99 percent of all hydrocodone globally.”