Physicians have always held their patients’ lives in their hands.

But now, they must do that and look over their shoulders — figuratively and literally. Physicians in southern West Virginia say the prescription drug abuse in the state has reached epidemic proportions. As if that were not a large enough public health issue, physicians must constantly be on guard for those purely seeking controlled substances. They must also deal with frequent health care facility disruptions and even threats of violence.

All of this, they say, has a seriously negative impact affecting all patients.

“It’s definitely a much bigger problem for the state of West Virginia than al-Qaida,” said Dr. Kevin McCann, an associate professor for the Marshall University School of Medicine’s Department of Family and Community Health.

“I think that the impact on West Virginia is severe. We have the quantity of deaths, the damage done to families and the lost productivity of individuals.”

The abuse problem has reached the point where it is affecting patient care, according to Dr. Anthony Dasaro, former director of hospital medicine at Raleigh General Hospital and current hospitalist at St. Francis Hospital in Charleston. Physicians are often more suspicious of people who say they are in pain. Hospital staff members have to deal with people trying to get their hands on narcotics along with caring for patients.

“If people are being really honest when they complain of pain, especially if it’s a younger person, they’re suspect,” he said. “There really has to be a kidney stone. It’s often nonsense until proven otherwise.”

Because many physicians have become increasingly uneasy about prescribing anyone a controlled substance, some patients truly needing help will likely be mistaken for those seeking medication to abuse, said Dr. Rhonda Hamm, a board-certified psychiatrist based in Lewisburg. That leads to some patients not getting the medication they need.

Also, some conditions — particularly psychiatric ones — have symptoms similar to drug withdrawal, she noted. People with those conditions could be easily be mistaken for addicts.

“Withdrawal from substances like alcohol and benzodiazepines (Schedule IV controlled substance sedatives) can have the same symptoms as a panic attack — increased heart rate, the shakes,” she said. “They have overlapping symptoms. I’m sure there’s been some people missed because of that.

“It’s a very difficult clinical decision. ... Every single physician makes errors. There are also people treated who are drug-seekers.

“It’s hard for patients. They are losing,” she said.

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Prescription drug addiction often has two beginnings, Hamm said. Some people are just trying to get high. Others get narcotics prescribed for legitimate reasons and later find themselves hooked.

Once someone comes off that needed prescription narcotic, she said, that person will often have cravings for it afterward.

“I know of a girl who was given prescription pain medicine after dental surgery,” she said. “She was taking it for legitimate pain, but she was still having cravings for it.”

McCann said, to him, most people begin with recreational use and experimentation. But once the users realize the drugs give them an “escape,” they’ll remember that when they run into life’s difficulties — or just have a bad day or week.

“Eventually, the product controls you,” he said.

Prescription drug abuse can make a people resort to anything, including crime, to support their habits, McCann said. For them, satisfying addictions is the same as other people satisfying hunger.

“The drugs of abuse can totally destroy an individual’s character and cause them to make decisions they would not otherwise make,” he said. “When you become addicted to something, now you have, unintentionally, this new drive in your body. (Satisfying the addiction) is equivalent to eating.

“But there are others who commit crimes who are not drug-addicted. They are criminals making money.”

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Dasaro said many people have “learned the system” when it comes to getting prescription narcotics. Hospital emergency rooms frequently give people narcotics via IV. Some abusers will fake chest pains to get that.

“And there’s no way to prove it,” he said. “Pain is something difficult to prove.”

Early in his career, Dasaro was working in an emergency room. A man came in one night, saying he had painful kidney stones. A urine test seemed to point in that direction. But a supervisor asked Dasaro if he had actually watched the patient urinate. Chances are, the man had pricked his finger and bled into that urine sample.

The supervisor threatened to call police and the man walked out, Dasaro said.

Those seeking prescription drugs craft a variety of stories, Dasaro said. They seem to know the best times to show up at hospitals, like when physicians are overwhelmed.

“They’ll say, ‘My roommate’s dog ate the bottle,’ or ‘My son threw it out the window and a car ran it over,’” he said.

“I have seen some people steal pain medication from their family members who are suffering from serious and terminal illnesses,” McCann said. “I have seen people who have broken into homes to take medications. I have seen patients attempt to go to more than one physician.

“I’ve heard of patients using someone else’s identity. That would not show up in databases.”

Physicians can use many different methods to find potential drug seekers, McCann said, including reviewing patient histories, obtaining drug screens, reviewing information from the state pharmacy board or even just speaking to that person.

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Some health care providers have even encountered violence or intimidation. In December 2009, Dr. Dennis Sandlin, a rural eastern Kentucky physician, was shot and killed while on the job. The suspect allegedly killed Sandlin after Sandlin would not write him a prescription for controlled substances.

“I’ve not had anyone threaten to kill me, personally, but I have had some verbal threats,” McCann said. “I have heard of some physicians being threatened because they would not prescribe someone controlled substances.”

“I had a gentleman grab my shirt one time, yelling he was desperate.”

A pharmacist was stabbed in the Lavalette area, where McCann practices.

Physicians are also dealing with constant disruptions — some of them outright chaotic — that have seriously affected their facilities’ operations.

“It’s creating a drain on the system, and it shouldn’t,” Dasaro said. “You see a patient in the middle of a hospital floor throwing a hissy fit wanting more Dilaudid and disrupting the hospital floor.

“You just shake your head and wonder where we are going with this.”

“I’ve had two issues with people being very, inappropriate,” Hamm said. “There was one man who faxed our office over and over and over again, and it tied up our phone lines. It was all because I wouldn’t call in a prescription for him. That happened all day.”

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While many physicians have become extremely guarded, others could be prescribing them liberally, Hamm said.

“Some doctors do have their hearts in the right place,” Hamm said. “They want to reduce their patients’ pain and make their lives better. But sometimes, that can have the opposite effect and make their lives worse.”

Some physicians, Hamm said, need to be more aware of characteristics that can make someone more prone to addiction, like personality disorders, history of addiction, a bad social support system, family histories of addiction and poverty.

Dasaro said he personally does not know physicians contributing to the problem, but he could see how someone else could find themselves “caught up.”

“I’ve heard of some trading pills for sex, but why should they risk their licenses? They would be caught eventually.

“The vast number of physicians want to help people. They’ll get burned often when they find out people are playing them.”

Some physicians have sat on the edge of patients’ beds for almost an hour explaining what will happen to them if their drug or alcohol use continues, Dasaro said.

“At the time, people are listening to you,” he said. “They thank you for your time and input. But you’ll take two steps away, and they’ll say, ‘You’re not going to change my meds, are you?’ You’re wondering, ‘Did you really hear what I said?’

“Doctors want to help people. That’s why we got into this. We lose sleep thinking about the people we care for. We want to treat people.

“It’s not that I don’t want to treat someone in pain. But personally, I don’t want to be someone’s drug dealer. Some people don’t believe that.”

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Dasaro, Hamm and McCann believe a federal prescription database could help physicians catch some potential “doctor shoppers.”

Dasaro said a centralized medical records system, in general, could be wonderful, noting it could also cut down on repeated, unnecessary tests.

“You could see who’s trying to milk the system and who isn’t,” he said.

Prescription drug addicts encompass people of all backgrounds, and no one is immune, the physicians said. Therefore, no one should ignore the problem.

“Don’t wait until someone in your family dies before you become aware of this problem. It’s too late then,” McCann said. “There are probably people around you who are addicted to these products, and you have no idea.”

“It’s like the movie ‘New Jack City’ when one of the characters says, ‘It’s not a black thing or a white thing,’” Dasaro said. “Drugs don’t discriminate against genders, economic classes or professions. In fact, when you look at Hollywood, the affluent often have more access. It’s discrimination in the worst way if you say it only affects the poor or economically disadvantaged. It can affect anybody.”

— E-mail: apridemore@register-herald.com