First few Article Sentences
Rachel became our patient in 2005, and just like hundreds of other patients, sought medical care because her back pain was limiting her ability to remain active. She had already failed trials of NSAIDs, muscle relaxants, antidepressants and physical therapy prescribed by other physicians. She denied any past drug use and scored low on the CAGE and ORT questionnaire (screening tools for alcohol and aberrant behavior.) She did respond to a low dose opiate and became a pain patient who received low dose methadone twice a day and oxycodone as needed. Rachel was the perfect pain patient, who never missed an appointment and whose random urine drug screens were always consistent until last week. Her urine drug test returned positive for methamphetamine and Rachel was discharged from controlled substances. She had relapsed after several years in recovery. She was referred to drug and alcohol treatment and to pain management for her pain. Unfortunately, no methadone clinic would take her because she was on methadone for pain and no other primary care clinic would take her as a patient because of her meth use. The only pain management clinic, who would accept her, had no openings for six weeks. She had taken her last methadone the day before she called and was afraid that she would start withdrawing from her opiate. She was already feeling irritable and experiencing nausea and cramping. The providers in our clinic were divided. One half wanted to keep her stable until she gets into pain management as long as she was no longer using meth while the other half refused to continue to prescribe an opiate medication to a patient who had relapsed, for fear of being sanctioned. Rachel’s case is a common real-life situation the health care providers in Oregon encounter every day. The number of patients using cocaine, heroin, and especially meth are increasing in Oregon, thuscontributing to a feeling of uneasiness among health care providers who have a moral obligation to treat their patients with fairness while try to avoid to be sanctioned for doing so. These pain patients do not disclose their past addiction because they know that most health care providers would turn them away, and the screening tools are not always answered honestly out of fear of being stigmatized. A lot of these patients, on Medicaid, have diagnoses that fall below the line and do not qualify for a referral to a pain management clinic. So the primary care providers find themselves dealing with patients who suffer from chronic pain that interferes with their ability to function, but who also have an undisclosed comorbid drug addiction. Data collected in 2006 by ECONorthwest indicated that illicit drug use was more prevalent in Oregon than in the nation as a whole, with a higher usage rate of marijuana, methamphetamine and the illicit use of prescription stimulants and pain relievers. About 10 percent of Oregonians age 18 to 25 use illicit drugs, this is 18 percent higher than the national rate of 8.5 percent.