Addiction to Painkillers And the Role Doctors Play

Elana Forgash

Forgash

Introduction

On a warm Father’s Day morning on June 19, 2011, 33 year old David Laffer, a

prescription painkiller addict, walked into a pharmacy in Medford, New York, pulled a .45-

caliber pistol out from a black knapsack, and shot and killed four innocent people in order to feed

his and his wife’s addiction to prescription painkillers. It was reported that before he left the

scene of the crime, he filled his backpack with more than 10,000 hydrocodone pills, opioid

painkillers used to treat moderate to severe pain. Police had even reported that the couple was

under the influence of narcotics when cops arrested them (Gardiner and Shallwani 2011).

However, what was even more troubling about this case is what came from the investigation

afterwards. Records showed that the couple had been prescribed a total of 4,251 prescription

pain pills in the first half of the year of the shooting. When investigators discovered the

enormous amounts of painkiller pills that were being prescribed to the couple, authorities turned

their attention to the doctors that had been prescribing the gunman with the massive amounts of

pain medication. Arrests were made for several of those doctors including, Dr. Eric Jacobson,

Dr. Frank Telang, and Dr. Stan Xuhui Li (CBS).

The silent epidemic of painkiller addiction and the involvement that doctors have in it is

an escalating issue in society and is insufficiently discussed in terms of everyday society. Instead

it is either sensationalized by the media or stigmatized by society. Unfortunately, the point at

which attention is usually drawn to the subject within society is typically when the doctors

2

Forgash

involved in prescribing painkillers to addicted patients begin to be blamed for the issue, and in

some cases even penalized. Society places a great deal of pressure on doctors and holds them to

an unrealistic standard. The co-occurring issue that society often overlooks concerning painkiller

addictions is the manipulation that doctors experience by prescription painkiller-addicted

patients. Patients that are addicted to prescriptions understand how to manipulate doctors in

order to keep a steady supply of their drug of choice. While a doctor is merely obliging by his

medical ethical obligations by treating the conditions of his patients, it is conceivable for him to

indirectly cause a separate condition in the process. When a doctor prescribes painkillers to a

patient thus treating the condition of that patient, the patient may subsequently become addicted

to the painkillers. When this occurs, the doctor is ironically both fulfilling and violating his

medical ethical obligations by simultaneously treating the pain condition and causing an

addiction. Although doctors may be both fulfilling and violating their medical ethical obligations

when they are prescribing painkillers to patients, the addicted patients are creating a relationship

of manipulation to maintain their supply of painkillers. Therefore, the growing trend in painkiller

addictions confirms that doctors should not be held entirely responsible for the addictions of their

patients. Instead, both doctor and patient must share equal blame in the matter.

Addiction In Society Today and Doctors’ Roles

Painkiller addiction is currently a prevalent issue in society; however, it is often

overlooked due to the taboo nature of addiction. The numbers of reported addictions to

prescription narcotics are on the rise. In fact, according to the National Institute of Drug Abuse,

3

Forgash

“7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th

graders, prescription drug misuse is now second only to cannabis” (NIDA). The abuse of

prescription painkillers in society is now at its peak. Even as it is becoming quite common in the

high school-aged youth of our nation, it still manages to be a matter that is simply inadequately

discussed. Partially to blame for the silent quality of this silent epidemic is the scandal that

society has placed on drug addiction. In response to this scandal, Jolene Sanders, a scholar in the

field of the double standards in relation to the societal views of both genders and addiction,

writes in her article, "Use of Mutual Support to Counteract the Effects of Socially Constructed

Stigma: Gender and Drug Addiction," “stigma is heavily associated with being a drug addict…”

(Sanders 237). In society there is a tremendous level of shame that accompanies the taboo

concept of addiction. This is undoubtedly caused by the social stigma cast on drug addicts.

Although one of the primary aspects of addictions being stigmatized in society is due to the fact

that most known drug addictions are affiliated with illegal drugs, part of this stigma certainly

carries over in the case of prescription drug addictions. As a result of the taboo nature and social

stigma associated with addictions in general, the topic of addiction is seldom discussed although

it may be prevalent in most neighborhoods.

Concurrently to blame for the silence of the subject of prescription pain medication

addiction is the societal view of doctors. Society in general tends to associate doctors and

medicine with prestige. There is a tremendous amount of respect and admiration toward doctors

and parallel to this, there is a tremendous amount of pride in being a doctor. In the article, “What

4

Forgash

is Medicine and What is a Doctor? Medical Students’ Perceptions and Expectations of Their

Academic and Professional Career,” Medical students at the University of Cape Town were

questioned about their motivation behind wanting to become doctors. The authors, Catherine

Draper and Graham Louw, noted that students “were found to have generally positive

perceptions of medicine and doctors, and depicted the medical profession as one that is very

significant because of its influence within society, to the point of being perceived as almost

noble” (Draper and Louw 103). It stands out that the author uses the word ‘noble’ to describe the

perception of doctors. Nobility characterizes the conception of being virtually perfect which

doctors understandably are not. Doctors serve a crucial role in society and are placed on a

figurative pedestal where they are held under a false standard of perfection. They are honored

and respected. However, in the case of opiate abuse in patients, doctors may in fact be at the

epicenter of the issue. Conversely, due to the high status that doctors uphold in society, it is not

common for doctors to be discussed or viewed in an ill manner making their involvement in

prescription painkiller addictions taboo. A paradox exists in the subject of painkiller addiction in

society due to the fact that it is an extremely prevalent occurrence in today’s society and yet it is

rarely addressed due to the high level of integrity associated with doctors and medicine. In order

to open up new discussion concerning the issue of the rise in addiction to painkillers prevalent in

society, we must dismantle the idealistic portrayal of doctors in society.

Due to painkillers having the potential of the backlash of addiction tied to them, they are

becoming a taboo. Concurrently, doctors are receiving great condemnation because they, as

5

Forgash

ethical practitioners, are prescribing the painkillers to ‘treat’ patients and thus are causing the

patients’ addiction. Doctors are held responsible to diagnose and treat any condition upon

evaluation and inevitably, with this great responsibility, great pressure follows. Doctors are

placed on a figurative pedestal in the social hierarchy of society and are greatly idolized.

Conversely, while treating a preexisting condition, and thus obliging by the ethical obligations of

doctors, if a doctor were to collaterally cause another condition, society is quick to demonize the

doctor. In the perspective that doctors are responsible for painkiller addiction, the societal

idolization of them perpetuates the taboo nature of the addiction due to the respected nature of

the medical field, thus perpetuating the problem of the rise in painkiller addiction by inhibiting

us from finding a solution. Although doctors may unintentionally cause the patient to become

addicted when they prescribe painkillers to treat the patients’ pain, the patients are equally at

fault in the matter for manipulating the physician once they realize they are addicted to the

medication in order to greedily maintain their supply of painkillers.

There are occasional cases in which both the doctor and the patient are held accountable

in the issue as should be expected. In the case of the pharmacy fiend, David Laffer, as mentioned

previously, the addiction that both he and his wife had to opiate painkillers was in fact so severe

that it lead to the shooting of four unfortunate bystanders in a pharmacy prescription robbery

including the store clerk, the pharmacist, and two customers. In David Laffer and his wife,

Melinda Brady’s vain attempt to fuel their addictions to prescription medications, four lives were

lost. While at first this incident was viewed as a very unfortunate tragedy, baffling pieces of the

6

Forgash

case began to surface. When it was discovered that the couple had been prescribed a total of

4,251 prescription painkiller pills all within the first half of the year of the shooting, it was clear

that something was not right. Laffer and Brady were found to have gone through a prescription

addiction process known as ‘doctor shopping,’ seeking out dozens of doctors and visiting

different physicians as often as 11 times a month in attempts to seek out pain medication to fuel

their addictions (Gardiner and Shallwani 2011). Laffer and Brady were each manipulating

countless doctors into prescribing them more painkillers than a single person should ever be

prescribed in half of a year. While most of the doctors involved may not have known they were

being taken advantage of, it was believed by authorities that others did and those were the

doctors that were arrested. Subsequently, when the case went to court on September 8, 2011

Laffer was sentenced to five life terms in prison without parole for the four murders. His wife,

Brady who helped plan the robbery and drove the getaway car, was sentenced to the maximum

of 25 years in prison for robbery (Gardiner and Shallwani 2011). In the case of David Laffer,

although an extreme scenario, both the doctors prescribing the painkillers and the painkiller-

addicted patients were held accountable for the issue.

Although doctors have received adequate training in the field of prescriptions, what they

lack however, is the knowledge of all the potential jeopardies of consuming pain prescriptions,

addiction being one of them. While in medical school, students receive little to no education

regarding addictions and yet in their later careers, they are managing and prescribing addictive

substances to patients (Jones 132). By doctors overprescribing painkillers or prescribing them

7

Forgash

recklessly without the knowledge of the potential effects it may have on the patient, they are

unknowingly abandoning the integrity of their degree. When a person graduates from medical

school and earns a license to practice medicine, he is held at a certain level of responsibility for

the wellbeing of his patients. It becomes his role to both treat and protect his patients (Jones

132). At that, when prescribing pain medication to treat his patient, he may be abandoning his

duty to protect the patient by exposing the patient to the possibility of an addiction to the

painkillers. After all, it is physicians that carry a degree and are professionals in the field of

medicine. Although they may have not received a thorough education on addictions specifically,

they do however, have an acquired knowledge about medications and the risks involved that a

patient may not have. As professionals in medicine it is the doctors’ ethical duty to treat and

protect their patient.

The Psychology of Addiction

In the 21st century, addiction is not a habit but a disease. The inevitable question of why

drug users continue to use their drug of choice is due to the presence of this disease. In most

standard cases, an addiction corresponds to a drug use, whether the drug in reference be an illicit

or prescription drug. Addiction, or drug dependence, is a medical diagnosis and according to the

official guidelines for substance dependence, “the diagnosis of substance dependence is based on

experiencing at least three of seven clinical criteria in a one year period: 1) tolerance; 2)

withdrawal; 3) heavy drug use over an extended time period; 4) uncontrolled use; 5) effort and

time finding drugs, using them, and recuperating after use; and 6) reluctance to participate in

8

Forgash

normal life events” (Freed 145). Similar to a doctor’s use of symptoms to diagnose a specific

illness, substance dependency can be diagnosed through an array of psychological evaluations.

Because of the fact that addiction is classified as a disease, when a medication is prescribed to a

patient by a doctor and produces an addiction, it can be viewed as the doctor causing a disease in

the patient.

The long-term use of a drug will coincide with the body’s build up of a tolerance. As

addiction expert, Alfred Lindesmith describes in his book, which defines in detail the

qualifications of an addiction, Addiction and Opiates, “the reversal of effects and the apparent

paradox that the drug user continues his habit only to feel ‘normal’ become intelligible; indeed,

they become integral aspects of the habit” (Lindesmith 78). The paradox the author discuses is

when a person starts to use a drug, he does it to feel better than he does at the given moment.

This could pertain to his wishes of feeling ‘high’ or even pain relief. However, after continuous

use of the drug, the person’s body builds a tolerance to the drug and the initial pleasant sensation

brought on by the drug eventually diminishes to nonexistence. Instead, the user feels much

worse than when he started to use the drug in the first place and is almost forced to continue the

use of the drug just to feel a sense of normalcy.

Typically, symptoms of withdrawal are purely associated with illicit street drugs. This is

the sensation the body experiences while coming off of a drug. A description of withdrawal

symptoms is given by an addiction expert in the following: “…the abstinence symptoms; that

host of painful sensations, intolerable feelings, oppressive organic disturbances of every sort,

9

Forgash

combined with psychic excitement, intense restlessness persistent insomnia” (Lindesmith 78).

The author mentions ‘the abstinence symptoms’ by these he is referring to the period of time

after opiates have stopped being taken after a period of continuous use. The intense sensations

that the author describes are the symptoms of withdrawal. Withdrawal is the process through

which the body, and the brain specifically, first become deprived of the synthetic dopamine that

the opiate painkillers were providing for them, and the brain is unable to recollect how to

produce it naturally. The body essentially experiences a period of extreme pain and discomfort.

The patient is also often unable to sleep. The withdrawal symptoms pertaining to opiates are

very real and are often described as “unbearable” (Lindesmith 78). Withdrawal is one of the key

factors in determining the presence of an addiction.

Painkiller Addiction and Doctors in the Media

Although there is generally an idolization of doctors in society, sometimes this can cause

the inverse, a demonization of doctors. A widely known case in the media currently and an

excellent portrayal of the idolization of doctors in society being turned sour, is the case of the

death of the famous pop legend Michael Jackson and the link to prescription painkillers. On the

afternoon of June 25, 2009 Michael Jackson died of cardiac arrest that was later discovered to be

the result of his active use of a multitude of prescription medications. These prescription

medications were proscribed to the pop singer by his personal physician, Dr. Conrad Murray,

who was also present on the scene when the singer went into cardiac arrest at his Sunset

Boulevard estate. Dr. Murray was being paid $150,000 a month to live with and treat the singer.

10

Forgash

In the toxicology report, at least six prescription drugs were found to be present in Jackson’s

system at his time of death. Immediately allegations pointed in the direction of Jackson’s

physician, Dr. Conrad Murray. As soon as a month after the pop star’s death there was a report

saying that, “the police already have their working suspicions-and they could entail charges of

manslaughter” (Hewitt). Before the trial had even begun, the police had already assumed the

guilt of the doctor. They jumped to the conclusion that Dr. Murray was completely and solely

responsible for Michael Jackson’s death and failed to take into account the manipulative

intentions of Jackson as an addict to prescription drugs. This illustrates the demonization of

doctors on a legal level in cases involving doctors, who are responsible professionals, and

patients, who are generally viewed as victims. The case went to court on September 27, 2011

concerning the involvement of the doctor in the death of Jackson. According to New York

Times, “the trial had focused primarily on whether Dr. Murray was guilty of abdicating his duty

or of acting with reckless criminal negligence, directly causing his patient’s death” (Hewitt). As

a licensed physician, Murray was expected to make conscientious decisions in regards to the

treatment of Michael Jackson despite Jackson’s social status. As quoted by the New York Times,

“‘a stockbroker could use money as a tool to persuade doctors to give them pills," says Dr.

Carole Lieberman, a Beverly Hills psychiatrist who has treated dozens of celebrities addicted to

painkillers, "but celebrities have the added benefit that sometimes doctors become starstruck’"

(New York Times). It is significant that the article uses the term ‘starstruck.’ A doctor is a

11

Forgash

licensed professional that is responsible for the patients that he is treating. It is extremely

unprofessional and reckless for a doctor to abandon his licensed duties because he is a fan of the

celebrity that he is treating. While it may be evident that Dr. Murray was influenced by

Jackson’s status and money, it is not uncommon for common doctors to fall victim to the

pressure of manipulative patients (Ohira et al. 106). The verdict for the case was announced on

November 7 2011 after 22 days of testimony and about eight hours of reflection and debate.

Ultimately, Dr. Murray was convicted guilty of involuntary manslaughter and was sentenced to 4

years in prison (New York Times).

Within the media, affluence and fame glorify drug use, including that of prescription

medications. The substance abuse and euphoria are emphasized while the inevitable addiction is

overlooked. The abuse of prescription pain medication for casual use is abundant among

celebrities in the media. An even greater issue, however, is the fact that society seems to be more

fixated on, or more aware of, issues in the media, such as the abundance and glamorization of

painkillers in Hollywood, rather than on societal issues, such as the spike in prescription

painkillers in the neighborhood. As stated by The New York Times regarding Michael Jackson’s

prescription overdose, “Jackson's death has cast a harsh light on the subculture of prescription-

drug abuse that exists in Hollywood” (Hewitt). While prescription drug abuse may in fact exist

heavily in Hollywood, it is also among us in everyday society. It seems as though the painkiller

addictions and overdoses in the media are much more known and discussed in society than those

12

Forgash

that exist in people’s everyday lives. Within society, prescription painkiller addictions are just as

relevant an issue as those that exist in the media. According to recent data, “pain is a presenting

complaint in over 80% of visits to physicians and contributes to significant health-care costs, yet

pain is often underrecognised and inadequately treated in primary care settings” (Walter,

Mooney, Hillhouse 301). In a large percent of instances of visits to physicians where complaints

of pain are relevant, prescription painkillers are prescribed to the patient as a quick ‘fix’ to the

problem. Every day in society people are being prescribed pain medications that perhaps are not

always necessary. These medications may or may not lead to an addiction. Every time a

physician prescribes prescription pain medication to a patient, he is taking a gamble against the

patient’s wellbeing. Despite the commonality of painkiller addictions that are known and

unknown, there are still few precautions being taken against preventing future cases of

addictions.

Society is trapped between the glamorization of casual prescription drug use in the media

and the idolization of the prestige of doctors in society. The doctors, while on one hand,

represent what is moral and righteous; on the other hand, they are the providers of prescription

painkillers, the very source of the addiction. With corruption lurking in either path, society will

choose in which direction it wants to go. David Laffer chose to follow the path of doctors and

prestige when he became addicted to the medication that the doctors prescribed him and

ultimately, this led him to a path of corruption ending in the deaths of four people and the arrests

of five. Society ultimately has a choice of which path of corruption it choses to cross. To blame

13

Forgash

for the inevitable corruption of society is both the doctors and the patients. The fault they both

have in common is the failure to make a change. The doctors fail to initiate a concrete system in

which records of patients’ additive and prescription history can be kept track of and accessed by

all doctors visited by the patient. The patient fails to choose to end the cycle once the addiction is

recognized. Instead of making a change, the patient choses to manipulate the doctors and thus

continue the cycle of addiction.

14

Forgash

Works Cited

Audience. "Prescription Drug Abuse | National Institute on Drug Abuse." National Institute on

Drug Abuse. N.p., n.d. Web. 5 Nov. 2012.

<http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse>.

Draper, Catherine, and Graham Louw. "What is Medicine and What is a Doctor? Medical

Students' Perceptions and Expectations of their Academic and Professional Career."

Medical Teacher 29.5 (2007): 100-7. Print.

Freed, Christopher R. "Addiction Medicine and Addiction Psychiatry in America:

Commonalities in the Medical Treatment of Addiction." Contemporary Drug Problems

37.1 (2010): 139-63. Print.

Gardiner, Sean, and Pervaiz Shallwani. "Special Grand Jury to Probe Doctor Shopping."

Newsday. N.p., 24 June 2011. Web. 29 Nov. 2012.

<http://www.newsday.com/news/breaking/special-grand-jury-to-probe-doctor-shopping-

1.3334394>.

15

Forgash

Heit, Howard A., and Douglas L. Gourlay. "Urine Drug Testing in Pain Medicine." Journal of

Pain & Symptom Management 27.3 (2004): 260. Print.

Hewitt, Bill, et al. "Michael Jackson's Death Drugs, Doctors & Deception." People 72.6 (2009):

52-5. Print.

Jones, Daniel. "Drug Addiction on the Wards: Are Junior Doctors Equipped?" Clinical Teacher

9.2 (2012): 132-3. Print.

Lindesmith, Alfred Ray. “The Nature of Addiction.” Addiction and Opiates. Chicago: Aldine

Pub. Co., 1968. Print.

Ling, Walter, Larissa Mooney, and Maureen Hillhouse. "Prescription Opioid Abuse, Pain and

Addiction: Clinical Issues and Implications." Drug & Alcohol Review 30.3 (2011): 300-5.

Print.

Medina, Jennifer. "Doctor Is Guilty in Michael Jackson’s Death - NYTimes.com."The New York

Times - Breaking News, World News & Multimedia. N.p., n.d. Web. 6 Nov. 2012.

<http://www.nytimes.com/2011/11/08/us/doctor-found-guilty-in-michael-jacksons-

death.html?pagewanted=all>.

"News." CBS New York. 2012 CBS Local Media, a Division of CBS Radio Inc., 21 Nov. 2008.

Web. 29 Nov. 2012. <http://newyork.cbslocal.com/2011/11/21/sources-doctor-who-

prescribed-medications-to-medford-pharmacy-shooter-david-laffer-arrested/>.

16

Forgash

Ohira, Yoshiyuki, et al. "Consultation Behaviour of Doctor-Shopping Patients and Factors that

Reduce Shopping." Journal of Evaluation in Clinical Practice 18.2 (2012): 433-40. Print.

Sanders, Jolene M. "Use of Mutual Support to Counteract the Effects of Socially Constructed

Stigma: Gender and Drug Addiction." Journal of Groups in Addiction & Recovery 7.2-4

(2012): 237-52. Print.

17