DRUG ABUSE - A PHYSICIAN'S PERSPECTIVE

I have been working here in Bryson City for almost four months now,
and have been troubled by some recent events.

My wife and I moved to Bryson City after feeling convicted by God to
join the group of outstanding physicians already established here.
Having just completed some training out in California, I was exposed
to a distinct population of patients that made practicing medicine
difficult, but I eventually developed a commitment and compassion
toward caring for them. This patient population I shall label
"drug-seekers." These patients occasionally come to the clinic, but
more often to the ER trying to obtain prescriptions for narcotic drugs
to either use for themselves or sell to make money.

Many of them frequent many hospital ERs over time, building up quite a
reputation in the medical community.

We physicians have become quite adept at identifying these patients
from among the masses we see, but it is a very difficult task. If we
make a mistake, we may deny someone adequate pain relief who is then
forced to suffer at home until their painful condition improves.

Similarly we may end up giving narcotics to someone who has
successfully fooled us into believing their pain was genuine.

I think we physicians prefer to err on the side of being overly
trusting, but it is a difficult line to decipher given the limited
time we have to spend with each patient.

The other night, while on call in the ER, I was able to identify one
of these patients almost immediately upon watching him "walk" into the
ER. We shall call him Mark and I have obtained permission from his
aunt to tell Mark's story.

Mark arrived at the Swain County ER Monday evening hobbling in on
crutches. He was complaining of uncontrolled back pains after using a
riding mower.

He claimed to have recently moved down to the Bryson City area from
Gastonia, and had a long history of back pains.

Before driving down, he had remembered to bring his MRI films and
x-rays of his back to verify his story of back pain, but had somehow
forgotten to bring his narcotic medicines which he uses daily to
control his back pains.

Red flag number one. He was requesting refills of his narcotic
medicines during an ER visit.

Red flag number two. I found this story a little difficult to
believe.While I awaited his hospital chart to review any past ER
visits, he hobbled out of his room to go out to the ER's ambulance bay
to smoke.

While out there we could hear him urinating on the side of the
hospital wall. Another red flag.

I was then at the point where I needed to make a decision whether to
give him narcotics, or refuse his request and send him back to his
primary doctor to obtain his medicines.

I chose the latter.

He then became very upset with me (red flag number four) and hobbled
out of the ER into the hospital lobby. We all gathered around the ER
monitor to watch him exit the hospital's entrance, and I was relieved
to see him walking out of the hospital with his crutches under one arm
and a lit cigarette in the other with no apparent limp. I had made the
right choice and was jokingly dubbed a "healer" by some of the staff.

I thought I had made the right decision.

That was, until early this morning when I spoke to one of the ER staff
who informed me that Mark had died of an apparent drug overdose from
"main-lining." Had I given him narcotics, perhaps this 30-year-old
young man would still be alive.

Perhaps he would have eventually cleaned up his life and become an
important member of our community.

Perhaps he may have gone into science and discovered a cure for
cancer, or AIDS, or even the common flu. But that will never happen
now, because he is dead. His death was not my fault, yet I still feel
the guilt.

He made the choice to use drugs, and his drugs killed him. But his
death has affected me, just as all senseless deaths do. This should
not have happened.

Perhaps if I had spent more time with him trying to convince him to
turn from drugs, I may have reached him, but there is no more time
left for Mark.

There IS time, however, for many other youth and adults in our area.
As a community we need to get more active in the fight against drugs.

I was hoping against all hope that the Bryson City area would not be
overly affected by this national epidemic.

I was wrong, dead wrong.

Drugs are here to stay. They are not going to go away without a
serious commitment by our whole community to make it happen.

I applaud those in our area who are currently involved to help
strengthen our community.

For parents who suspect their kids may be using drugs, you need to
confront your children.

It's not an easy task, but a necessary one. Our children are dying
senselessly and we are losing our future.

We need to be the examples for our children and educate them at an
earlier age of the dangers they will face as they grow up.

For those who are currently using drugs, I beg of you to reconsider
the lifestyle you have chosen.

Think of the money wasted annually on what ends up being only a
"temporary high". Think of what it is doing to your family, your
parents, your kids, your friends.

You can stop if you want to, and we want to help. For those who are
serious about breaking the chains that bind them, I would like to
help. Without your help and desire to quit, I can do nothing. With
your help, together we can work miracles and restore your life to what
it was intended to be, what you hope it could someday become.

Tom Bunnow, MD