Crusador Interviews Dr. X

January 1, 2005

Dr. X Exposes The Dark & Dangerous World Of Prescription Pain Pills

CRUSADOR Editor Greg Ciola Interviews Anonymous Medical Doctor About The Multi-Billion Dollar Underground Pain Pill Business

Big Pharma is engaged in highly questionable practices regarding the marketing of OxyContin and numerous other opioid-based prescription pain medications. In their wake is a trail of addiction, death, and broken lives.  Big Pharma is not the only one to blame for this growing crisis, however.  The federal government is equally as responsible because they have given their seal of approval by passing legislation that mandates all patients, regardless of their medical condition, have a right to demand prescription pain pills, even if they don’t have pain.  All they have to do is say, “I have pain” and the doctor is legally obligated to write them a script.

Doctors are told that if they don’t go along with the pharmaceutical “drug pushers” and freely administer as much opioid pain pills as the patients demand, they face the loss of their medical license.  This subject is so sensitive in nature that most doctors are afraid to even speak out, fearing the loss of not only their job, but their entire career.

In this issue of CRUSADOR, one upset doctor has decided to blow the whistle in order to alert Americans.  He has chosen to remain anonymous and only be known as “Dr. X” because of the repercussions that would soon follow if his identity were known.

Crusador:  Dr. X, thank you for having the courage to come forward and expose what’s occurring in the world of prescription pain pills.  Tell our readers a little bit about your background and why they need to be aware of this issue. 

Dr. X:  Well, my name is Dr. X, and forgive me if I don’t use my name because I don’t want my name published because of what could happen to me -- both to my license, my practice, or to the medical system.

I’ve been in practice a long time. I’m a graduate of a medical school of the United States.  I’ve gone through legitimate training, in residency programs that had been approved and have board certifications in multiple areas.  I won’t give you any more details than that.  I’ve been in both private practice, and I’ve also worked for hospital systems; but, again, don’t want to give you further information on that.

In the United States today there is a new political force that’s very quiet and very powerful.  It’s what we call the “pain lobby”.  The “pain lobby” not only represents pharmaceutical companies that produce opioid or addicting chronic medications, but also people who promote the use of these medications.
              
You probably heard of people who promote anabolic steroid use in athletics?  We know that these people think using anabolic steroids is good for you; that there’s nothing morally wrong with it, ethically wrong with it, or legally wrong with it.  They think there’s no higher use of drugs than to promote athletic performance.
              
Well, along those same lines, there’s a group of people far more powerful in numbers and political influence than what I call a “steroid cabal”. I call them the “opiate cabal”.  This cabal takes drugs, which have a very important use in the control of pain, and expands their use to the general population to feel good, even if there’s nothing medically wrong with you.  We’re talking about legitimate medical authorities, legitimate pharmaceutical companies, and people within the federal government and federal legislatures that are now promoting laws that state:  If you feel you have pain, whether there’s anything wrong with you or not, you have a legitimate federal legal right to use chronic opioid medications.
              
When I first got in this business doctors thought that they could treat chronic pain.  I’m going to differentiate between acute pain and chronic pain.
              
If you are in a car accident and you break your femur, and you’ve got a compound fracture and the bone is sticking out of your thigh, and you’re screaming on the ground, then yes, it’s very appropriate to use any medication to control your pain, to ease your suffering, and to improve your ability to get better; and that includes the opioid-based        medications of which there are many kinds.  There are many different types of pain medications. 

If you wake up from an operation, you just delivered your baby with a C-section, you just had a brain tumor taken out of your head, you just had heart surgery, your body’s going to hurt.  So the use of medications to relieve suffering and promote your recovery are very important.  That’s acute pain and generally you’re over that in a finite period of time.  You may shatter your thigh and a week later you’re fine.  You may be in bed with a rod down your thigh and you may not be able to put weight on it for six months, but since the acute injury is over with and your soft tissue injury has been sewn up and healed, generally the use of these acute pain medicines drops off rather rapidly.  Plenty of people wake up from heart surgery in agony and a week later they’re on the treadmill working out. 

Then you have the use of opioid medication in the treatment of non-malignant pain.  As I was mentioning when I first got into this business, we thought we could treat chronic, non-cancer or non-malignant pain through the use of exercise, behavior modification, non-steroidal anti-inflammatory medications, a little electricity, electrical stimulation, maybe some antidepressant medications, but it was a functionally-based treatment, long-term to help people not only manage their pain -- not get rid of it -- but manage their pain while we increased their physical function.  If you have a legitimate problem that gives you chronic pain, work through it, control it, adapt to it.
              
Around 1990, I went to a medical conference and this pendulum had swung imperceptibly -- and I hadn’t even noticed it -- completely over to the other side.  We had people saying -- which is now the norm, 15 years later -- that if a patient states they have pain, then they should have as much opioid medication as they want until they state -- and this is open-ended -- they don’t have any pain.
          
Crusador: This is written as actual legislation, correct?
         
Dr. X:  Yes.  Go on a search engine for pain and you’ll find federal statements stating that the patient has a right to have treatment to stop their pain.  
          
Crusador:   I’m sure the pharmaceutical companies were behind endorsing that legislation and getting it passed weren’t they?.
         
Dr. X:  It’s more than that.  It’s not just the pharmaceutical companies. It’s the people using the pain management.  You know, the drug pushers aren’t the people driving steroid use, it’s the body builders who want to use the steroids.  Well, it’s the same thing.  There’s a lobby of people who want to use these drugs, over and beyond the pharmaceuticals, even if there was no profit motive, this would still be the norm.
         
Now, let’s go further.  I didn’t say there’s anything wrong with them.  There are conditions that are chronic that are very, very painful.  You may have heard of the reflex sympathetic dystrophy now known as complex regional pain syndrome, Types I and II.  There are people with certain toxic poisonings, like lead poisonings and there are people with diabetes and other diseases that have chronic, unremitting pain; although in some people’s opinion actually opioid medications, because of where they work in the spinal cord or the brain are probably not the best for these, but some people have unremitting pain.
              
There are people with migraine headaches and atypical facial pains who have agonizing pain and we all believe it’s real and you have to come up with a way of controlling it.  But we’re going a step further.  We’re saying, “I state I have pain.  My back hurts.  I strained it.  So I need medication to control it.”  Well, what is the end point for this?  There is no end point.  It’s open-ended.
              
I have people coming in the office and they’ll state to me, “I have a carpal tunnel syndrome and I need pain control, and I need this amount of OxyContin.”
         
Crusador:   So they’re actually telling you what they need?
         
Dr. X:  That’s exactly right.  And I’m saying to them, “I’ve never put someone with carpal tunnel syndrome on a narcotic medication.  It’s just a little pain at the wrist.”  We’re not talking about you had your leg chopped off.  We’re not talking about you had a heart attack and you had your chest split open.  We’re talking about a minor nerve compression in the wrist.  And if you really want to take care of it, you have the surgery on it, but it’s not that painful.  I’ve never put anybody on anything more than Tylenol or Motrin for that.
              
OxyContin is not a bad medication or a good medication; it’s an effective medication that people have found out how to abuse.  OxyContin is a long-acting oxycodone that’s released over 10-12 hours. But drug addicts found out if they take this pill, grind it up and either swallow it or inject it, they get all the medication within a few minutes instead of 12 hours and they get a rush.
          
Crusador:  I heard that teenagers are even sniffing it.
         
Dr. X:  This is new to me.
          
Crusador:   It’s true.  They crush it into a powder and sniff it.
         
Dr. X:  And they die from that because you’re taking 12 hours of medication in five minutes.  But people are coming in with nothing wrong with them and they’re not taking 10 milligrams of OxyContin, which is equal to about eight Percocet.  They’re taking 800 milligrams of OxyContin three times a day.  I can’t believe that.  That’s an impossible dose.  If I gave you that dose it would be enough to kill three people!
          
Crusador:   So they’re building up to this dosage?
                  
Dr. X:  Yes. And then they need more and more.  So we’re not treating pain.  We’re treating addiction and we’re legitimizing it by saying it’s okay to treat your addiction, but we’re not claiming that’s what it is.  I won’t get into how to treat addiction.  That’s outside of my area.

Crusador:  Oxycodone, which is prescribed heavily today is still the main ingredient in OxyContin, isn’t it?

Dr. X:  Yes, but there’s many other medications.  There’s Fentanyl, a transdermal patch.  There’s Avandia.  There’s morphine sulfate.  There’s Methadone.

Crusador:  Methadone?
         
Dr. X:  Yes.
          
Crusador:   I was going to ask you about that.  That one’s been getting a lot of press lately.  They give it to people coming off of drugs.  Why would you give a drug addict another drug?
         
Dr. X:  That’s for maintenance.  It doesn’t get you too high.  It fulfills your need without getting a big rush, they say.
          
Crusador:  This addiction crosses all economic and social classes -- all the way from the Rush Limbaugh’s to the alcoholic on the street.
         
Dr. X:  Yes.  And, it has happened because the prescriptions are easy to get. Doctors may be pressured into writing an unnecessary prescription simply because a patient demands it.          

For example, I had a man in his late 20s walk into my office that looked vigorous, strong, and happy say to me, “I have pain in my back and I’ve come here to get my pain medication.”
              
I said, “Well, I’ve never met you before.  I don’t know who you are.  I don’t have any records.”

He printed up for me from a federal website on pain control that it was his right to have pain control.  If doctors don’t agree with this, they can lose their license and be thrown off medical staffs.
          
Crusador:   Is that right?
         
Dr. X:  Yes.  We have to sign documents saying that we understand pain control and part of pain control is doing what the patient wants.
          
Crusador:  So now it doesn’t take long when someone has that information on the street, to pass it to the next person and the next person and this thing spreads like wildfire.
         
Dr. X:  Yes.  My answer to him was, “Well, you have the right to ask and I have the right to refuse.”
          
Crusador:  Do you really have the right to refuse?

Dr. X:  Maybe not.  That’s a good question.  I said to this patient, you know, “I’ve looked at you, and I can’t find anything wrong with you that warrants the use of any pain medication, let alone strong narcotic medications. So I can’t help you.” 

I’m going to give them their money back by just saying, “I can’t find a reason.”
              
Now, many of my patients are referred to me by neurosurgeons, brain surgeons, back surgeons and spinal surgeons.  Even with these patients I try to keep their opioid medication down as well as I can. 
              
Now, many of the times when I see a patient coming in with a drug 100 times that which would be lethal for all of us in this room, I say to myself, is he diverting the medication?  Is he getting the medication and selling it on the street?  Is he giving it to someone else?  My general feeling is that the doctors who are doing this are a little misguided.  They think they’re doing the right thing and they don’t follow their patients to find out if they’re actually taking the medication.
          
Crusador:   Not all of them, though.  Some of them have to know what’s going on.
         
Dr. X:  Yes.  That’s my opinion too.  But I’ve given them the benefit of the doubt.
                   
Crusador:  You told me before conducting this interview that you could make $20,000 a day prescribing pain medicine. Is that true?
         
Dr. X:  Easily. $20,000 is nothing! 200 patients at $200 a piece is how much?  What does that come up to?
          
Crusador:  $40,000
         
Dr. X:  Easy.  I know people doing it.  That’s not the practice of medicine anymore. Some clinics are open 24 hours a day with hundreds of people lined up around the block.  If you pay cash, you don’t have to wait in line.  If you pay with insurance, you wait in line.  If you pay with insurance it’s $100. If you pay with cash it’s $200.
          
Crusador:  Is this going on all over the country?
         
Dr. X:  Yes.  As long as you take a thorough medical examination and document, “The patient states he has pain,” you’re meeting the criteria to use the drugs.
          
Crusador:  Technically you’re a drug disbursement point legally?
         
Dr. X:  Yes.  You’re a legal outlet for opiate drugs.  The allure is quick, easy money.
                    
Crusador:  Medical doctors have become slaves to this scam haven’t they?
         
Dr. X:  Yes.  People who do cosmetic botox make a lot of money and that’s cash trade.  The plastic surgeons who do cosmetic procedures like facelifts and breast augmentations, they’re a cash trade.  People who do the eye surgery to correct your vision, that’s basically a cash trade.
              
Most doctors are seeing their wages diminish dramatically because they’re employees of an indentured system that they have no power in. So legitimately or not, some physicians have figured out how to get out of the system and generate money through their own hard work. 

So we have the federal government promoting the use of opioid medications supposedly for chronic pain, even though there may not be anything wrong with you.   The chronic use of opioids causes changes in your health and brain.  Don’t let anybody kid you.  It destroys your frontal lobes after 20 or 30 years, changes them, destroys your initiative, basically you’re mad and you start to lose your emotions. 
          
Crusador:   Plus it leads to crime because it takes more and more to feed the habit.  There are a lot of drugstores and pharmacies getting broken into as addicts seek to feed their habit or sell it on the street.
         
Dr. X:  Well, I think many of the drug addicts aren’t sophisticated enough to state they have chronic pain.  They could walk in and get what they want.
                    
Crusador:   Have any of your superiors come down on you for not prescribing?
         
Dr. X:  No, because I covered my tracks very closely.  What I say is, “I’m not set up to monitor you on these medications. What I’ll do is I’ll make recommendations to your family doctor who has a good group.”
          
Crusador: Can you tell us about the issue of people personally getting hooked on these opioid medications innocently, unbeknownst to them versus those that are out there really abusing it?
         
Dr. X:  It happens all the time.
          
Crusador: And how quickly can that happen?
         
Dr. X:  Sometimes days.  I knew a very fine spinal surgeon who operated on people who didn’t need it.  That’s the way spinal surgeons are.  I’m sure he was doing a couple million a year. He was charging $30,000 and doing five procedures a week like that.  Five times $30,000 is $150,000 a week.
              
He would put people on OxyContin, not for a week, but four, five, six months.  And then he’d say, “Well, you know, your surgery’s healed. I don’t need to see you anymore because I’m a surgeon.  Since I don’t have any reason to operate on you, I can’t take care of you.  By the way, go see Dr. X, he’ll take care of you now.”
              
So they’d show up at my door after they’ve been on OxyContin for six months and I wonder, “Now, what am I going to do?”
          
Crusador: You know they’re addicted.
         
Dr. X:  You bet they are.  And these are people who actually have a reason to have pain.  When you look at their x-ray you don’t know why they’re walking.  I wish they would send me these patients before they had their operation. But, that would never happen, because they wouldn’t get their money. So these people are addicted.  They’re in the system, and it’s very hard for them to get out. 
          
Crusador: Why did Rush Limbaugh have to go through back channels to get pain medicine?  He should have just said, “I’ve got pain.”
         
Dr. X:  You know what, you’d be surprised.  As powerful as he is and as smart as he is, he may not have realized he could have done that.  He said, “This medicine is not holding me.  I need this amount of OxyContin.”  Or the addiction got so powerful he could not do what I just said.  You know, he had to have some.  He needed more.
          
Crusador: That’s what it sounded like, according to his housekeeper.
         
Dr. X:  But they say there’s already a way around that with federal law.  They say one of the reasons why people who you think are looking for drugs or a drug-seeking behavior do not have drug-seeking behavior is that they’re actually under-medicated for their pain.
              
So you’re confusing people who are in pain and who are under-medicated as being opioid seekers or showing drug-seeking behavior.  The treatment to that is to give enough medication so they don’t have pain.  So you close the loop with them.  You’ve given them a legitimate reason to get more medication.
         
Crusador:  Now, can the patients actually say what dose they want?
         
Dr. X:  Absolutely.
         
Crusador: And how many pills they want?
         
Dr. X:  Absolutely.  Because they say, “Doctor, you gave me 80 milligrams twice a day on OxyContin.  It didn’t hold me.  I had to take four a day.    The medication wasn’t strong enough.  I have the right to control my own pain.”
          
Crusador:  How long would you write a script for? 
         
Dr. X:    When I was doing a lot of this, I would write 30 days.  No refills.  That’s it.
          
Crusador:  This is across the board in the medical profession? Anybody can go to any type doctor for their pain.
         
Dr. X:  Yes.
          
Crusador:  You could be an ear doctor or a dentist?
                             
Dr. X:  Absolutely. 

Crusador:  How long could an average doctor write you a prescription for OxyContin?
         
Dr. X: They can write prescriptions indefinitely. 

Crusador:  So they’ve basically turned doctors in America into legalized drug pushers?
         
Dr. X:  Yes. It’s bigger than the pharmaceutical companies.  There’s a market driving this.
          
Crusador:  The federal government and legislators at that level, they’ve got to be aware that this is going on?
         
Dr. X:  They’re the ones promoting it.  They’re actively promoting it with federal law stating, “We have to treat these people.”
          
Crusador:  Knowing that more and more people are becoming addicts they could change it, but they don’t. How much are the insurance companies covering? 
         
Dr. X:  Interestingly enough, they are not covering a lot.  With most insurance companies, you have to pay for your own drugs. If you’re on Medicaid, drugs are free.   When it comes to opioids, I have never met anyone who’s stated that the money or amount was a problem.
          
Crusador:  Plus you’re dealing with two types of people; those who need it for their pain and then become addicted and those that are reselling it on the street.  They don’t care about insurance companies. Who cares if you have to pay $100; you sell it for $10,000.  This is frightening stuff.  Why did you stop writing prescriptions for Oxycontin?

Dr. X:  I stopped because I felt it was too dangerous. I saw advertisements in newspapers.  “Have you been given OxyContin?  Call the law firm of such and such if your doctor made you an addict.”  I said, “That’s it.  I’m done.”

Crusador:  Sounds like you made a wise choice…Thank you for coming forward and warning the public about this serious issue.