A Two Pronged Problem: Pain Management & Opioid Deaths

How do we respond to both the need for pain facilities and the increasing number of opioid deaths? 

Two-Pronged Problem: Pain And Opioid Deaths

WATCH: Rich Kellman reports on pain management and opioid abuse

Two-Pronged Problem: Pain And Opioid Deaths

BUFFALO, NY-- The closing of the Eugene Gosy pain clinic just over a year ago in Williamsville was a wakeup call to two things: the scarcity of pain management facilities, and the epidemic of opioid overdose deaths throughout the nation.

How do we respond to both the need for pain facilities and the increasing number of opioid deaths?

Two things emerge: Not enough long-term research on the dangers of long-term opioid pain medications when drug companies began selling them about 10 years ago, and the need to combat opioid addiction deaths through a comprehensive community-wide effort with doctors, hospitals, insurance and drug companies, nurse practitioners, mental health professionals--everybody--working together.

Gosy's arrest last year forced the public to confront a contradiction. His many patients depended on him for relief from debilitating pain. "He was the one that was giving the medicine so that I could live a decent life," said one.

Another patient told us, "Patients at Dr. Gosy's practice are really suffering. Some days, the waiting rooms there look like victims of an airplane crash all gathered together."

And yet, Eugene Gosey was charged with exploiting those patients for his own profit. Said John Flickinger, DEA Resident Agent in Charge, "Really, in this case, he was just like a drug trafficker..."

Added then-US Attorney William Hochul, "... in other words, acting like a drug dealer without medical reason to prescribe these drugs."

Retired orthopedic surgeon Dr. Joseph Cardamone says that doesn't sound like the Dr. Gosy he knows.

Cardamone referred his patients to Gosy, and says Gosy demonstrated strict adherence to opioid regulations. "If they came in and they were taking other medication or had other drugs in their system than what he prescribed, they were basically out of his practice, and they knew it."

"He was a good guy?" we ask.

"I think he was, I think he still is."

The case has been an eye opener over the past year, about opioids, addiction, and what comes after.

"We are in the midst of the worst drug overdose epidemic in American history," says Horizon Health Services President and CEO Anne Constantino. "You kind of hope to see the trend reversing, and of course the trend has done nothing but go up."

The main drivers of drug overdose deaths are opioids, according to the CDC, pain meds, the synthetic drug fentanyl and heroin among them. There were an estimated 33-thousand deaths in 2015, more than the number of gun homicides and traffic deaths combined.

In Erie County, Health Commissioner Dr. Gale Burstein works at a graph on her computer, calculating last year's numbers. "Confirmed and suspected opioid deaths in Erie County, a sharp increase in 2016. And in 2017, averaging about one suspected opioid death a day." She pauses. "It's really awful."

In late March, Daniel Adamczyk of Cheektowaga died of a heroin overdose. For seven years he struggled with pain from an accident. He was prescribed opioids, had his good times and bad, but finally turned to heroin.

"Heroin is everywhere," says Danny's mother Christine. "And once it gets into the point where you cannot control it, your brain takes over telling you, 'you need it, you need it, you need it,' you will do anything to get it."

And you can get it cheaper on the streets than medication. But often with an added kick, the drug Fentanyl. It's dozens of times more powerful than heroin, and a tiny amount can kill a grown man.

 "The addiction is tenacious, it will never let you go," says Kellman.

"It won't," Christine says, "and that's the sad thing, it won't let you go."

Today, the pain clinic is back up and running. Dr. Gosy is also back, under court permission, to help protect "...innocent patients....", according to Federal Judge Mark Schroeder.

WEB EXTRA: Interview with Dr. Christopher Kerr, CEO of Hospice Buffalo, who was one of the three doctors who enabled the Gosy clinic to reopen in June 2016

Interview with Dr. Christopher Kerr, MD, CEO of Hospice Buffalo

The new clinic director is Dr. James Hitt, who aims to measure the risks and benefits of medication. "It's definitely going to be the focus of the future, what are the risks and how do you identify them when you're treating chronic pain in a medical setting, and what are the benefits we're looking for."

Hitt recently hired chiropractor Dr. Antonino Carlino to provide active care. "Active care," says Carlino, "meaning they're in PT, physical therapy, doing exercise rehab for their spine, they're actually doing something, they're not sitting on a couch just taking medication."

How the opioid addiction crisis began is a story that goes back at least ten years. Anne Constantino of Horizon Health Services: "About ten years ago, we first started seeing the prescription pain killers come in, and we saw the first couple of deaths."

UB professor Dr. Hanna Grol-Prokopczyk has found there were few if any studies of the long-term use of opioid painkillers. "In just the past couple of years," she says, "we are seeing more and more research showing that there are long-term negative consequences to opioid use, even for people who are using the drugs exactly as prescribed."

"We're expending a lot of money dealing with it," says Erie County Executive Mark Poloncarz. The county has filed a lawsuit against drugmakers it claims used aggressive marketing, minimizing the risks of what they were selling. "The drug companies sold and created these drugs and said they were a safe alternative when in fact, they knew they were not, and now we've created a nation of addicts," said Poloncarz.

Dr. Robert Milch is a specialist in palliative care, and was a founder of Hospice Buffalo. He helped reopen the Gosy clinic last year, and in this crisis, he sees an opportunity, "...an opportunity as a community, that will help bring us out of this darkness."

Bring together everyone, he says, doctors, nurses, social workers, hospitals, insurance and drug companies, public officials, law enforcement, the medical school. "This will only be dealt with by a comprehensive approach. You cannot just bring a hammer down on one practitioner and think you're addressing the issue," said Dr. Milch.

Dr. Gale Burstein says, "We just have to embrace that we have this problem in our community, and we have to beat the stigma and realize this is people that we love and respect in our community, are struggling with this."

The stories are heartbreaking, the numbers...breathtaking. In two years, nationwide, there were more opioid deaths than the number of Americans who died in Vietnam. it is an American crisis, it is a Western New York crisis. Says Burstein,  "Y'know, this problem is in your backyard."

And so it is.

In the legal case against Gosy, both sides expect that he won't go to trial for at least a year. The maximum sentence would be 20 years, with a fine of $1,000,000.
 

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