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5/18/2015 12:00 AM

Jeffrey Lynne, a lawyer based in Florida who represents treatment programs in zoning and other issues, says it’s about time that some drug testing arrangements are being cut back by payers (see ADAW, May 11). Lynne, who is a partner with Weiner, Lynne & Thompson in Delray Beach, said that insurance companies are suing treatment providers to get their money back for excessive and unnecessary testing in “clawback lawsuits.” He tells his clients that if they submit such claims, insurance companies will say it’s insurance fraud.

“You don’t need a clinician to tell you how many times you need to test someone,” Lynne told ADAW. “If you’re coming into my detox, I need to test you once to see what you’re on and how much of it.” For patients who are in residential treatment, under 24-hour supervised care, testing is necessary only if a patient is acting strangely, he said. “But if a patient is under your care 24 hours a day, seven days a week, why would you have any reason to test them?” he asked.

(This is the second of a two-part series on drug testing and treatment centers.)

Jeffrey Lynne, a lawyer based in Florida who represents treatment programs in zoning and other issues, says it’s about time that some drug testing arrangements are being cut back by payers (see ADAW, May 11). Lynne, who is a partner with Weiner, Lynne & Thompson in Delray Beach, said that insurance companies are suing treatment providers to get their money back for excessive and unnecessary testing in “clawback lawsuits.” He tells his clients that if they submit such claims, insurance companies will say it’s insurance fraud.

“You don’t need a clinician to tell you how many times you need to test someone,” Lynne told ADAW. “If you’re coming into my detox, I need to test you once to see what you’re on and how much of it.” For patients who are in residential treatment, under 24-hour supervised care, testing is necessary only if a patient is acting strangely, he said. “But if a patient is under your care 24 hours a day, seven days a week, why would you have any reason to test them?” he asked.

On the other hand, outpatient programs, as well as sober living residences, are doing the testing. Many sober living residences require patients to be tested once a day in order to live there — and if patients test positive, they’re kicked out.

Treatment centers and sober homes want to have their own lab so they can send their patients to it and get the money. For Medicaid and Medicare, this is a violation of anti-kickback law, but there is no such law that applies to private payers that are out-of-network (not contracted).

Desktop analyzers and more

The lure of the testing income was so great, Lynne related, that it first led programs to buy desktop analyzers so they could satisfy insurance company requirements for accuracy. Then, when they learned that a lab would have to perform the quantitative confirmatory test, they had to lease the costly machine that could do the confirmatory testing. Centers “shared” the machine. Other companies wandered into the market saying they were turnkey and would do everything for the center — but wanted a cut of whatever got billed and collected.

Billing companies were driving this trend, said Lynne. “Some billing companies say not only do you need to do the desktop analyzer but also the confirming test. And apparently you can bill one hundred dollars a panel at 15 substances per test per patient,” he said. “If I have a sober house with eight residents, and I can bill fifteen hundred dollars a day for each, you do the math.”

Unfair competition for labs

James Fratantonio, Pharm.D., manager of applied clinical research and education for Dominion Diagnostics, a lab based in Rhode Island that was recommended as a source by Marvin Ventrell, the executive director of the National Association of Addiction Treatment Programs (NAATP), said that labs performing clinical tests on patients need to be approved by CLIA and the College of American Pathologists, and must be audited. “You can’t just rent out machinery,” he said. “You need a lab director, you are regulated, your lab director needs a Ph.D. or an M.D.”

Fratantonio is concerned about the desktop analyzers with unregulated operations. “I do think this is going on, and I do not think that the competition out there is fair,” he told ADAW.

Drug testing is a clinical tool, which means it should be individualized to the patient, said Fratantonio. It would make sense to test a patient who was admitted for a cocaine use disorder for cocaine, but if the patient comes in showing symptoms of sedation, it would be good to test for benzodiazepines and opioids as well.

There are also esoteric drugs — and drugs that contain substances that are entirely unknown, such as “Spice” or “bath salts” — which won’t necessarily show up in standard tests, he said. “Nobody knows what’s in them,” he said. There are tests that can be run, but these are more costly. And they’re not likely to be done by anybody but a reference lab like Dominion Diagnostics.

It’s also important to test for therapeutic medications, to make sure the patient is taking them and not diverting them. This is true for buprenorphine, methadone, and opioids prescribed for pain as well. While there is no evidence to correlate urine drug levels with therapeutic range, “we can make judgment calls based on pharmacokinetic principles,” he said.

The value of testing

Sean Murphy, M.D., medical director of the Harmony Foundation (where the NAATP’s Ventrell is business manager), mainly uses testing for new admissions. Murphy has been providing treatment in residential detoxification programs for about 25 years — 14 in Colorado and, before that, 11 in California. “The technology has changed a lot over this time,” he said. “Ten years ago we sent everything to Texas, and the results were good, but it was a very slow turnaround time.” It took a week to get results back, so the testing just “wasn’t that useful,” said Murphy. “It did give a clear picture of their overall drug use pattern,” he said, noting that it clarified for a counselor what patients were really using. “The history the patient gives isn’t completely reliable — if you ask a diabetic what they’re eating, you’re not going to get the right answer.”

Now, Murphy uses Dominion Diagnostics, and the turnaround time is less than 24 hours — even though this time the samples go from Colorado to Rhode Island. The test results “help me treating people for their withdrawal,” he said. “With the narcotic explosion, there are so many types of drugs, with people using this and that — they can’t even remember what they’re using,” he said. “Someone may mainly use oxycodone, but took a couple Suboxone, chewed a fentanyl patch — they just don’t remember.”

Drug tests can also help Murphy’s patients who come in with alcohol or benzodiazepine dependence. Because withdrawal from these two substances can cause seizures, knowing what the patient was taking can inform Murphy’s treatment and help prevent seizures, he said.

Most of the testing Murphy does is for new admissions. As for ongoing testing, he only does it on a random basis, as a deterrent, due to costs, he said. The kind of random testing he does is more similar to workplace rather than clinical testing — two patients’ names a week are drawn at random for testing, saving money in testing costs. However, the down side is that because the patients are chosen at random, these aren’t really clinical tests, and Murphy doesn’t bill either the insurance company or the patient for them. It didn’t seem fair, said Murphy, to give a patient a bill for $300 because he or she was randomly selected to be tested. “We don’t want to pass the cost on to someone, and the insurance companies won’t pay for it,” he said. “But we can’t spend $25,000 a year on this anymore.”

There is really no good option other than a clinical lab, however. “Part of the problem is that the dipstick testing is not very reliable,” said Murphy. “We’ve been through six brands — and they all have a 50-percent error rate.” Murphy gives every new patient a dipstick test, to see if it confirms the patient history. Then, he sends the sample to the lab.

Laboratory testing is expensive, said Murphy. “We’re still searching for some other alternatives, for some lower-cost testing,” he said. “But it might be slower; we might have to give up a little accuracy.”

The Harmony Foundation doesn’t contract with any insurance companies, so there is no specific assigned lab that pays for each patient’s tests. The struggles reflect the considerations of a physician who is trying to give the best clinical care to his patients — and that, says Lynne, should be the only purpose of drug testing. “People need to know that urinalysis testing should not be viewed as a source of revenue,” said Lynne. “It should not be part of the business plan.”

Fratantonio’s final advice to treatment centers looking at urine drug testing as a profit center: “If you think that something is too good to be true — it is.”

Bottom Line…

Drug tests should enhance a patient’s care, not a center’s profit.

3/23/2015 12:00 AM

The federal Centers for Disease Control and Prevention (CDC) has requested funding to bolster state prescription drug monitoring programs (PDMPs) by linking them to electronic health records (EHRs) and linking both to law enforcement. The purpose is “to improve clinical decision-making and to inform implementation of insurance innovations and evaluation of state-level policies,” according to the Congressional Justification (CJ) (the narrative supporting an agency’s budget request). “In addition, the increased investment will support rigorous monitoring and evaluation, and improvements in data quality, with an emphasis on delivering real-time mortality surveillance,” the CJ says. “CDC also will scale up activities to improve patient safety by bringing together health systems and health departments to develop and track pain management and opioid prescribing quality measures in states with the highest prescribing rates.”

The federal Centers for Disease Control and Prevention (CDC) has requested funding to bolster state prescription drug monitoring programs (PDMPs) by linking them to electronic health records (EHRs) and linking both to law enforcement. The purpose is “to improve clinical decision-making and to inform implementation of insurance innovations and evaluation of state-level policies,” according to the Congressional Justification (CJ) (the narrative supporting an agency’s budget request). “In addition, the increased investment will support rigorous monitoring and evaluation, and improvements in data quality, with an emphasis on delivering real-time mortality surveillance,” the CJ says. “CDC also will scale up activities to improve patient safety by bringing together health systems and health departments to develop and track pain management and opioid prescribing quality measures in states with the highest prescribing rates.”

The CDC will also join with the Department of Justice, according to the CJ, for the purposes of making PDMPs more widely used “for clinical decision-making.”

By linking insurance strategies to PDMPs, there is a risk of “creating a much larger field of information to be mined by law enforcement, insurers and others,” said H. Westley Clark, M.D., former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), in an email to ADAW. “The objective,” he said, “is to link PDMP data to health outcome data, and to trigger alerts within the PDMP system to identify high-risk patients.”

The databases of physicians writing prescriptions for opioids and pharmacists filling them will be a “gold mine” for law enforcement, said Clark, who is a lawyer. Of particular concern are patients in treatment with methadone in opioid treatment programs (OTPs), which do not currently have to input data into PDMPs thanks to a “Dear Colleague Letter” written by Clark when he was at CSAT (see ADAW, Oct. 24, 2011). “How can these data not be of interest to federal and state law enforcement? Even if the PDMP data are hearsay, the investigations launched as a result of PDMP data will be enough to discourage physicians to prescribe for pain and for OTPs to question the utility of participating in PDMPs,” Clark said.

Creating confidential informants

Clark added that law enforcement can also use information from PDMPs and electronic health records to create confidential informants against physicians and pharmacists — people who were illegally selling their prescriptions, and cut a deal with law enforcement to ensnare the prescribers and dispensers. “Some would see this as a good thing,” he said. “But others would wonder if further converting the medical record into a chess piece on a criminal justice game board is a wise thing to do.”

Through PDMP data, law enforcement can also elicit affidavits from prescribers and pharmacists, said Clark. “They can use those affidavits to pressure patients to identify buyers and sellers of their drugs,” he said. “Deals will be made, and the consequences may not be pretty.”

The CDC is asking Congress for funds so that states will “demonstrate collaboration with a variety of state entities, including law enforcement,” according to the CJ. Clark is very concerned about this, because it “pulls law enforcement deeper into the realm of health care delivery.”

If SAMHSA decides to require OTPs to input patient data into the PDMP, that is tantamount to opening up the OTPs to law enforcement. At that point, as Clark put it, there will be a “whole new ball game.”

Response from CDC, ASAM

The CDC press office declined to make a subject-matter expert available for an interview to respond to our questions. By email, we asked the CDC why it, as a health agency, is encouraging the use of health records as tool of criminal prosecution. The response came by email from Brittany Behm: “Collaborations are a vital part of building an effective program to prevent prescription drug overdoses. No single player can address all the levers that impact drug overdose prevention, and success in this work is not possible without effective collaboration with key stakeholders. This includes coordination and cooperation between public health, law enforcement, substance abuse services authorities, and other sectors to advance prevention and protect those at risk for opioid misuse, abuse, and overdose.” The “public health approach” to preventing drug overdose death by the CDC has three parts, she said: (1) improving data quality and surveillance to monitor and respond to the epidemic, (2) supporting states in their efforts to implement effective solutions and interventions and (3) equipping health care providers with the data and tools needed to improve the safety of their patients.

Finally, we asked if there is concern that curbing access to prescription opioids could have the effect of increasing heroin use, as people with addiction find their supply cut off or too expensive. “There is no evidence that PDMPs lead to heroin use,” Behm said.

We also asked Stuart Gitlow, M.D., president of the American Society of Addiction Medicine (ASAM), to comment on the CDC’s proposed expansion of PDMPs. “ASAM supports PDMPs as a methodology of reducing the potential of diversion and misuse,” he told ADAW in an email. “We do not, however, support the intersection of medical and law enforcement information and therefore are extremely uncomfortable with the concept of law enforcement having access to PDMPs. From there, it would be a short step to law enforcement having access to medical records to determine if patients are utilizing illicit substances, thus placing a damper on patients and physicians having open and private conversations. Even without such access, information in law enforcement’s hands as to the medications prescribed to patients provides likely diagnostic information to law enforcement, a likely driver toward patients preferring to obtain even appropriate prescriptions through illicit means.”

For the CDC CJ, go to http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2016_CDC_CJ_FINAL.pdf.

2/23/2015 12:00 AM

Saying that police officers should not be able to search through patients’ “electronic medicine cabinets” without a search warrant, Utah state Senator Todd Weiler is calling for law enforcement to obtain a search warrant before looking up someone’s records in the 19-year-old Utah Controlled Substance Database Program, the state’s prescription drug monitoring program (PDMP).

Weiler said that physicians and pharmacists should check the database, but that law enforcement has abused it. “We’ve had a problem in Utah, because law enforcement can go to the database, put in a case number and check anybody they want,” Weiler told ADAW. “One cop in Salt Lake City checked the database for almost 500 firefighters, because some morphine that was in an ambulance went missing,” he said. “This was just a fishing expedition.” One firefighter, said Weiler, was arrested in front of his wife and teenage daughter based on the database search — but he had prescriptions for all of his medications, and all of his doctors knew about each other. “He had to spend $3,000 on a lawyer,” he said. “It was like a nightmare from a Communist country.”

In another case, a police officer who was addicted to opioids “would look up to see who had just filled a prescription, and would go to that person’s home and steal it,” said Senator Weiler. “These are the two examples I’m using, but I expect I could find a lot more.”

The only solution is for law enforcement to be required to obtain a search warrant before going into the database, said Senator Weiler. Otherwise, they are violating the 4th Amendment rights of citizens to be free from unlawful searches.

“The law enforcement community is fighting back,” he said. “But I’m not going to apologize for the 4th Amendment being inconvenient.”

Senator Weiler supports pharmacists and physicians checking the database to make sure patients aren’t doctor-shopping to obtain addictive medications.

For the bill, go to http://le.utah.gov/~2015/bills/static/SB0119.html.

From the Field
4/27/2015 12:00 AM

Opinion on marijuana has changed dramatically in the United States. The public increasingly perceives it as a benign substance, and there is growing interest in its potential medicinal uses. Already almost half of the states have medical marijuana laws, and congressional bills have recently been proposed that would reschedule the drug to reduce hindrances to research and facilitate marijuana’s use as medicine.

Advocates tout marijuana as a miracle drug with a wide range of potential therapeutic uses, while public health voices raise alarms about its dangers if made more widely available. The science justifying either position is often not as robust or clear as its partisans would wish. Marijuana’s impact on lung cancer remains unclear, for instance, but so does its actual range of medicinal benefits. The urgent need for more research is something all sides in the current marijuana debate can agree on. Policy changes around marijuana will need to be informed, as much as possible, by science.

There is solid evidence that the main psychoactive ingredient in marijuana, THC, is effective at controlling nausea and boosting appetite. There is also some preliminary evidence that THC or related cannabinoid compounds such as cannabidiol (CBD) may also have uses in treating autoimmune diseases, inflammation, pain, seizures and psychiatric disorders, including substance use disorders. Despite claims of marijuana’s usefulness in treating post-traumatic stress disorder, supporting data is minimal, and studies have not investigated whether symptoms may worsen after treatment is discontinued.

We do not yet know all the ways chronic treatment with marijuana or marijuana-derived compounds could affect people who are rendered vulnerable either by their illnesses or by their age. We also don’t know how medical marijuana laws will affect other aspects of public health and safety. For example, wider medical marijuana use could potentially impact driver safety, as both laboratory and epidemiological research link recent marijuana use to increased accident risk, likely reflecting marijuana’s disruptive effects on motor coordination and time perception.

Impact on teenagers

Perhaps the biggest public health concern around medical marijuana liberalization and legalization concerns the potential impact on teenagers, who could have greater access to it as a drug of abuse and who may increasingly see marijuana as a “safe, natural” medicine rather than a harmful intoxicant. Although there is still much to learn about marijuana’s impact on the developing brain, the existing science paints a picture of lasting adverse consequences when the drug is used heavily prior to the completion of brain maturation in young adulthood. In teens, marijuana appears to impair cognitive development, may lower IQ and may precipitate psychosis in individuals with a genetic vulnerability.

Most states currently don’t allow medical marijuana for children, but they too are vulnerable. Accidental ingestion of marijuana edibles by children has increased in Colorado since marijuana was decriminalized for medicinal use in 2009. Also potentially concerning is the possibility of increased prenatal exposure if women self-treat with marijuana to control nausea associated with pregnancy. Research suggests prenatal exposure could have adverse consequences for children’s future health and brain development. There is as yet no research on the potential effects of secondhand marijuana smoke on children growing up in households where parents smoke.

Even in conditions for which THC, CBD or other cannabinoid constituents of the marijuana plant prove to be medically beneficial, consumption of the marijuana plant itself or its crude extracts via smoking, vaporizing or eating is unlikely to be the most effective, reliable or safe way for patients to obtain these benefits. Laboratory research is ongoing to better understand how cannabinoids work in the brain and body and hopefully guide development of safe, reliable therapeutic compounds that have a minimum of adverse side effects.

Existing medications

Two THC-based medications, dronabinol and nabilone, are already approved by the Food and Drug Administration to treat nausea caused by chemotherapy and to boost appetite in patients with AIDS wasting syndrome. The United Kingdom, Canada and several European countries have approved a drug called nabiximols (Sativex), containing THC and CBD, as a medication for spasticity caused by multiple sclerosis (MS) and, in Canada, for MS- and cancer-related pain. Despite its success in reducing pain and spasticity, it has not received approval in the United States, and recent evidence has found impairments in cognition in users.

CBD on its own is not psychoactive and it actually mitigates the “high” produced by THC; it has been studied as a potential antipsychotic drug, and ongoing trials are testing its efficacy as an antiseizure agent. Some parents of children with severe forms of pediatric epilepsy have claimed that high-CBD (and low-THC) marijuana extracts control their children’s seizures better than existing medicines. The maker of Sativex has recently created a CBD-based drug called Epidiolex to treat children with these conditions, and is in the process of conducting initial small-scale trials. Evidence so far shows that CBD is only effective in controlling seizures in a small subset of patients.

As public approval for medical marijuana grows, we need to ensure that our policy decisions are science-based and not swayed by the enthusiastic claims made widely in the media or on the Internet. We need to support and encourage increased research on marijuana’s potential benefits and conduct intensified research on the cannabinoid system to inform the development of safe, FDA-approvable drugs. But the existing science on marijuana’s adverse effects on youth demands we also proceed with caution in making policy changes that could result in increased use of or exposure to marijuana by young people.

From the Field
10/27/2014 12:00 AM

Last week, the Harm Reduction Coalition held its conference in Baltimore. Marijuana legalization is not one of its issues, which are mainly access to clean needles and syringes, overdose prevention with naloxone, HIV and hepatitis C, and the rights of drug users. Keynote speaker Michael Botticelli, acting director of the Office of National Drug Control Policy (ONDCP), supports naloxone and medication-assisted treatment. He is a clear harm reduction advocate, but not an advocate of marijuana legalization.

But harm reduction sometimes gets confused with marijuana legalization. I had the privilege of speaking to the “Politics” class at American University in nearby Washington, D.C. on October 20, a few days before the conference was to begin. I was invited to discuss the movement toward drug legalization. I also covered some “harm reduction” assertions as well.

Unfortunately, because the legalization movement is sweeping across America, my counterpoints were very well-received — I say “unfortunately” because we are being overcome by the tidal wave of the movement. Here is some of what I said to Assistant Professor Rick Semiatin’s “Washington Semester” class of juniors and seniors from 200 colleges and universities across the United States.

I’m a “liberal” on most things, but on the drug issue, I know the harm that is done by car crashes, DUIs, date rape and the impact of flooding already overcrowded emergency rooms — and that includes from marijuana, which most “legalizers” claim they want to separate from “harder” drugs. I was the one who wrote then-Congressman Ed Koch’s testimony on his bill in the 1970s to legalize marijuana, and sat with him at the table as he told Congress that drugs are personal and harmless, and that we should stop crowding our prisons. But both Ed and I learned and changed our positions, he as mayor of New York City and me as I learned more and more as spokesman for the House Narcotics Committee and then the White House ONDCP.

I told the students that the election is being overwhelmed by the issue because my own party, the Democrats, don’t want to touch it. They are afraid their candidates will lose a big chunk of the youth and liberal base who support legalization/decriminalization in the legislatures and state referenda. Like laetrile in the 1970s (which was legalized in more than 20 states and was supposed to cure cancer but turned out to be useless apricot pits that simply deferred real and needed treatment), “medical” marijuana is backed up only anecdotally and never is compared to an “n” of other treatment modalities that would be prescribed by doctors. There is truth to former drug czar Barry McCaffrey’s joke that a shot of gin also takes away your pain. Having said that, no one wants to deny a truly sick or dying patient who wants to get high the opportunity to feel better, even if it’s a placebo effect. It’s not the truly “medical” cases anyone wants to stop; it’s what law enforcement tells us are the 90-percent-plus (and as many as 99 percent) nonsick people who also come in to the clinics feigning illness with a makeshift letter just to get drugs.

Harms of marijuana

The evidence on harm in the legalizing states is rolling in. You have to scrounge for the reports, but they say, “youth marijuana use increased by nearly 11 percent since medical marijuana became legal in 2009,” “traffic fatalities involving drivers testing positive for marijuana have increased by 100 percent between 2007 and 2012” and “toxicology reports with positive marijuana results for driving under the influence have increased 16 percent from 2011 to 2013.” In addition, Colorado Public Radio reported, “Denver Emergency Room Doctor Seeing More Patients for Marijuana Edibles.” The United Nations reported, “Marijuana-related Health Problems on Rise in US,” with a 12 percent rise last year in marijuana usage by teens.

But for the most part, the legalization referenda are speeding ahead. The most-cited ones, in Oregon and D.C., show legalization 11 and 20 points up, respectively, with just days before the election, and the legalization advocates say they are counting on “young voter turnout.” Since Democrats count on that demographic as well, you can understand the silence.

Even though Maryland Governor Martin O’Malley told me personally two weeks ago that “I’m concerned about legalization” because of car crashes, emergency room upticks, the horrible message to kids (how legalization disarms parents from the moral high ground on the message), and the like, politicians in the state are silent on the issue.

Of course, the legalizers say the drug war is a “failure.” But the students I addressed did open their eyes when I said that because of the efforts of parents, teachers, coaches and religious and business leaders, and a strong foreign policy (Plan Colombia) and domestic enforcement efforts, drug use has declined almost 50 percent in the last three decades, and cocaine use — the disproportionate driver of crime — is down 70 percent. If any other social problem, such as literacy, hunger or poverty, or health problem, such as cancer, diabetes and heart attacks, improved 50–70 percent, would we call it a failure?

To these quite smart college juniors and seniors, I pointed out that medically assisted treatment — including methadone, buprenorphine and Vivitrol — is in fact harm reduction. It’s valid because people can function, work and pay taxes. But if we’re talking about heroin, cocaine and methamphetamine to addicts, that’s pure nonsense that destroys their lives. If we are talking about marijuana, I still oppose it because it jams hospital emergency rooms with car crashes and treatment centers with patients. Legalization or decriminalization would simply increase availability and use. When I debate the Ethan Nadelmanns of the world on radio or Bill Maher or Crossfire, they invariably say, “That’s true but…” I cut in and say, “You can’t say ‘but’ to more availability and use — that’s the point. Aside from that, Mrs. Lincoln, how was the play?”

I do concede we need to stop prison overcrowding but point out that’s why Attorney General Janet Reno and ONDCP Director McCaffrey supported creating drug courts, for treatment instead of prison for nonviolent drug offenders. There were eight drug courts when we started in 1996. Drug courts rose to 1,000 under Clinton-Reno-McCaffrey, and now are near 3,000.

Science, not politics, should guide U.S. drug policy.

From the Field
8/25/2014 12:00 AM

One of the greatest NFL players of all time, if not the greatest, is Lawrence Taylor. Known as LT, his struggles with cocaine are as well known as his quarterback sacks.

Thurman Thomas was one of the most versatile players of his era, a strong, tough, speedy back who was elected to the Hall of Fame. His battles with alcohol are well documented.

Max McGee scored the first touchdown in Super Bowl history. However, he is better known for playing that famous game with a hangover.

Substance abuse, in any form, is nothing new to the NFL — not even the abuse of painkillers, as one of the best quarterbacks in history, Brett Favre, has publicly struggled with addiction to Vicodin. Jason Peter, a lesser-known player but a highly touted defensive prospect when at school in Nebraska, became addicted to painkillers while in the NFL, which in turn led to a heroin addiction.

There is a criminal aspect to substance abuse as well. In this regard, entire teams have been investigated in the past. The New Orleans Saints — no strangers to team-wide discipline from the league — had its entire franchise under suspicion. Team officials were accused in a 2010 lawsuit of covering up the theft of the prescription narcotic Vicodin from team headquarters, an allegation that triggered an investigation by the U.S. Drug Enforcement Administration. Kyle Turley, an offensive lineman for eight years who retired after the 2007 season, said it was common for members of the Saints’ medical staff to routinely hand out the prescription painkiller Vicodin on the flights home — regardless of whether a player had a prescription for it.

“The trainers and the doctors used to go down the aisle and say, ‘Who needs what?’” Turley said. “If you had something hurting and needed a painkiller to take the edge off so you could sleep that night, they made sure you had it,” he said in a piece first published by ESPN.

Entire league under investigation

Yet now, it is not an individual being investigated, or even just one franchise. It’s the entire league. Agents from the Drug Enforcement Administration’s New York division are reaching out to former players to learn how NFL doctors and trainers get access to potent narcotics such as Percodan and Vicodin, according to the New York Daily News. The investigation was prompted after more than 1,300 former players joined in a lawsuit against the league, alleging that the league illegally used painkillers to mask injuries and that the NFL obtained and administered the drugs illegally without prescriptions. The lawsuit also claimed that the league failed to warn players about potential side effects. The reasons for this abuse, according to the players, were to expedite the return of injured players to the field and generate the highest possible profits.

The nine named plaintiffs include Chicago Bears quarterback and Super Bowl champion Jim McMahon, and his Bears teammate, Hall of Fame defensive end Richard Dent. The lawsuit alleges that the NFL has violated state and federal drug laws. The drugs numbed pain, allowing hurt players to return to the field, but they also led to aggravated injuries and created long-term health problems — both in terms of the underlying physical injuries being aggravated and in the form of addiction.

Complaints by players

Also, NFL retirees have long complained that the disability program the league operates jointly with the Players Association seems designed to reject claims by players physically debilitated by football-related injuries. Not only do these claims need to be accepted, but the insurance carriers must recognize that substance abuse and addiction must be treated as well, especially if a player’s team, or the entire league, was negligent in distributing controlled substances to those without a prescription, or even to those with a prescription if the player was not properly monitored while on the drug.

There’s a reason a medication requiring a prescription is a “controlled substance.” Without the “control” aspect, it can indeed lead to abuse and dangerous implications for the user. In many cases, even with tight controls, addiction is still a risk. If the allegations are true, not only were teams promoting substance abuse, but they were adding one more health problem to a player’s already existing injuries, without thought or consideration to the player’s welfare. Just reimagine Turley’s story for a minute, with one wrinkle: imagine team officials walking down the aisle of the plane with baggies of heroin, passing them out indiscriminately. Sounds pretty insane, doesn’t it? That’s how reckless these team officials were.

Painkiller misuse

A scientific study conducted by researchers at Washington University in St. Louis found that retired NFL players misuse opioid pain medications at a rate more than four times that of the general population. The study, co-funded by ESPN and the National Institute on Drug Abuse, provides new evidence to suggest the roots of that misuse can be traced to the misuse of painkillers during players’ NFL careers. Linda Cottler, a professor of epidemiology in Washington University’s Department of Psychiatry, who directed the research, said, “That’s a problem, I think, that only 37 percent got [prescription pain medications] exclusively from a doctor…. It tells me that there has to be more evaluation, more monitoring.”

Between the drug policy violations and the concussion issue, we are forced to recognize that football is a gladiatorial sport. Pain is inflicted, often and in large amounts. This author, for one, accepts that and, to be candid, enjoys the sport to a level of fanaticism. While the league looks for new ways to prevent concussions, via equipment and rule changes, one has to wonder if they can ever be truly done away with based on how the game is played. Concussions might be down in recent years, but they are far from being eliminated. Can rules be implemented to cut down on painkiller abuse? The answer in a perfect world is “yes,” but in reality, any player who is injured wants to get back to playing as fast as possible — not only because of their competitive nature and drive to win, but for fear if they do not, they will lose their job and their livelihood.

Much of the news about the NFL lately has been about their drug policy. Numerous players have been suspended anywhere from one game to an entire season, based on the number of times the policy was violated. In many of the cases, the violations were for marijuana use, which has caused a debate as to whether marijuana use should be the harbinger of such stiff penalties. Maybe, instead, we should be looking at the hypocrisy of the league, as some players are suspended while others become addicts and the league turns a blind eye.

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  • Meet the Editor

    Alison Knopf
    Editor

    Alison Knopf is a professional journalist who began covering the addiction field in 1984 as founding editor of Substance Abuse Report. She has been the editor of Alcoholism & Drug Abuse Weekly since 2005.
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