As feds crack down on clinics accused of being pill mills, patients are left without their painkillers, and sometimes nowhere to turn

Courier Journal photo by Beth Warren

Thousands of patients with chronic pain in the Louisville area have been displaced by local, state and federal crackdowns on clinics accused of being pill mills, defrauding Medicaid, or both, and it's likely to get worse, Beth Warren reports for the Courier Journal.

One of those patients is retiree Michael Anderson, 67, who suffers from occipital neuralgia: electric-shock-like chronic pain in the neck and back of the head. He told Warren that depended on opioids to manage his pain, and his supply was abruptly cut off when investigators raided his pain clinic. "I'm in dire need," he said.

Such cases are likely to become more common, Warren writes, because Russell Coleman, U.S. Attorney for the Western District of Kentucky, says more investigations are underway as part of a national effort. Attorney General Jeff Sessions created a task force in February to target opioid abuse, including over-prescribing of pain and addiction medicines.

"Doctors say the federal raids on medical clinics lead to unintended consequences — patients thrust into painful withdrawals and left vulnerable to suicide or dangerous street drugs," Warren writes.

Dr. Kelly Clark, a Louisville addiction specialist who heads the American Society of Addiction Medicine, told Warren there aren't enough addiction or pain specialists to accommodate the influx of patients from clinic closures, and the problem will only get worse.

Dr. Wayne Tuckson, president of the Greater Louisville Medical Society, told Warren that area physicians are working on a coordinated response to help these patients, including creating a hotline with a list of resources, including pain-management physicians willing to care for them.

When investigators "go in with a sledgehammer and shut down a practice without consulting community physicians, suddenly we have patients thrown loose," Tuckson told Warren. "We do have a significant overdose problem and we have to do something about that. But we have to be careful that our actions do not jeopardize the care of patients."

Displaced patients may have trouble finding new doctors because investigators have seized their patient histories and doctors are wary of getting caught up in the crackdown. Many general practitioners who haven't received pain-management training refuse to prescribe high doses of narcotics, largely out of fear of losing their licenses, Tuckson said.

"Docs are very much afraid when it comes to writing pain medications," he told Warren.  "We don’t want patients to become addicted. And we don’t want to have our licenses — and therefore our livelihoods — at stake."

Clark told her, "If a practice is closed, the patients who are legitimately taking their medications as prescribed can be in a dire situation. They look and feel extremely sick."

He added, "Some patients likely will end up in emergency rooms from opioid withdrawals, which can cause cramps, chills, sweats, vomiting, diarrhea, sleeplessness and dehydration. For patients who are dependent — not addicted — they will feel better after a few days of withdrawals. Those who are addicted wouldn't be able to voluntarily taper off and going through withdrawals wouldn't stop cravings."