Docs who say no to opioid use face threats from sufferers

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Doctors who say no to opioid use face threats from patients

This Tuesday, February 9, 2021, law enforcement personnel are walking towards the Allina Health clinic where several people were shot dead in Buffalo, Minnesota. Doctors say they are facing an increasing threat of violence because they refuse to prescribe opioids or wean patients off the addictive pain medication. The problem was underscored by filming Tuesday at the Minnesota clinic. (David Joles / Star Tribune via AP, File)

A patient threatened to call Dr. Shoot Terry Hunt when physical therapy wasn't as effective at relieving his pain as opioids. Another harassed his co-workers and roamed a hospital looking for Hunt after being told he was being weaned from pain medication he had been using inappropriately.

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

When he heard of the attack Tuesday at a medical clinic in Buffalo, Minnesota, in which one person died and four were injured, "the first thing I assumed was something to do with pain medication," said Hunt, who is now they work for the Mayo Clinic in Rochester, Minnesota, and a health care facility at the Mayo Clinic in Red Wing, Minnesota. "We ask about our own workplace: How safe are we?"

Authorities said 67-year-old Gregory Paul Ulrich was upset with his medical treatment before shooting five workers and detonating three apparent pipe bombs at an Allina Health clinic. According to a police report, he threatened a similar mass shooting in 2018, allegedly in revenge on people he said had "tortured" him with back surgery and prescribed medication.

A former roommate said Ulrich was upset when a doctor stopped prescribing pain medication and Ulrich was also taking other medications and had untreated mental health problems. Law enforcement and the healthcare system did not address the specifics of Ulrich's treatment or medication.

Doctors who treat pain say the threat of violence has increased significantly in recent years as mounting legal and regulatory pressures from the deadly opioid epidemic led many to prescribe alternatives and discourage their patients from addictive pain medication.

While some patients benefit from careful opioid use and doctors don't want to stigmatize them, many are better off using other therapies to manage pain, experts say. But many become addicted to drugs, often for short-term use after surgery.

"It hijacked your brain," said Dr. Carrie DeLone, Penn State Health Community Medical Group regional medical director. "You don't see yourself as problematic."

The pain specialist Dr. Andrew Kolodny, professor at Brandeis University and founder of Physicians for Responsible Opioid Prescribing, said patients are convinced that opioids treat their underlying problem because when they try to skip a dose or when their previous dose wears off, " They feel terrible and in pain "when it may be the withdrawal that causes pain hypersensitivity.

"It's much easier to give the patient what they want. You write the prescription … you walk out the door happy and there are no problems. It is much more difficult to help a patient rejuvenate … "said Kolodny.

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

"We kept patients waiting in parking lots for doctors to harass them. We made them say, 'We're going to shoot you' or 'We're going to burn your house down,'" DeLone said .

Almost half of pain specialists interviewed during a violence education session at a meeting of the American Academy of Pain Medicine in 2019 cited opioid management as the reason for their threat, said Dr. W. Michael Hooten, President-elect of the Organization.

In response to threats, doctors have fired patients. But they also installed alarm systems and panic buttons and set up examination rooms so that the doctors are closest to the door. Some even advocate carrying guns, Hooten said, noting that smaller clinics are at the greatest risk because they may not be able to afford safety.

After his threat in 2018, the police took Ulrich for a mental examination and Allina took legal action to exclude him from the company's property. A temporary injunction forbade Ulrich from contacting the doctor or entering the clinic and the nearby Buffalo Hospital, run by Allina, where he once frightened a nurse so much that a colleague pressed a panic button for help.

Police said they had not had any recent interactions with Ulrich, who raised the alarm prior to the attack in Buffalo, a small town about 40 miles northwest of Minneapolis.

St. Joseph County, Indiana, prosecutor Ken Cotter said he was unaware that such threats were common until 2017, when a man shot and killed a doctor who refused to prescribe opioids for his wife. Michael Jarvis attacked Dr. Todd Graham in a parking lot hours after the appointment, Cotter said, adding there was evidence that Jarvis was also using opioids. Jarvis took his own life soon after.

Before that, Cotter said, "I can't remember ever reading a threat report" from a doctor who said he received calls from around 20 doctors after the shooting telling him how common they were. "They took (threats) as a business expense."

According to Cotter, about a dozen meetings were held with doctors, law enforcement officers, and others to discuss how doctors can be protected, including de-escalating stressful situations, but also alternatives to opioids, disposing of old drugs, and tackling the addiction problems that are theirs Plague communities.

"When doctors call to say we have to do something, this is … literally the crusade of our entire community," said Cotter.

Kolodny, from Brandeis, said he had been compared to Hitler, threatened on Twitter, and a bag of nails sent to his home. Protesters carried signs near his office last month sacking him for working to reduce opioid use and help states bring lawsuits against opioid manufacturers.

The threats "got really scary," he said. "It just got really hot."

Pain sufferers taking opioids cannot get in the door in more than half of primary care clinics

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