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Hospital Commissioners
Anytown, USA


Dear Hospital Commissioners,

I am writing to you regarding our county hospital care or lack of care of two groups of patients: patients with addictive disorders and patients with mental health disorders. This letter will address addictive disorders.

Regarding addiction, please see the attached Centers for Disease Control Grand Rounds from January 13, 2012. This describes an epidemic of prescription drug overdoses throughout the US. This is usually opiate medicines combined with either alcohol or sedatives or sleep medicines or some combination. These are not patients who are buying drugs, using them illegally or abusing them. These are patients who are taking their medication as described and dying from being too sedated. This epidemic killed 27,000 people in 2007 and continues: it killed more people than car wrecks and more people than cocaine and heroin overdoses combined.

As you surely know, Washington State passed a law regarding primary care providers and chronic pain medicines, in order to try to decrease the amount of opiates and pain medicines given out and to reduce the overdose death rate. Opiates are also addictive and even chronic pain patients who take their medicine correctly will usually become opiate dependent. The DSM IV description of psychiatric disorders separated opiate dependence and opiate addiction, but the DSM V combines them into a spectrum: mild, moderate or severe. That is, most patients will be hooked.

The University of Washington Pain and Addiction Clinic has been offering free courses in opiate addiction treatment including prescribing information about buprenorphine. Buprenorphine is a replacement therapy, safer than methadone. A rural doctor can prescribe it to help either opiate dependant patients get under control and still help the pain, or it can be used for heroin dependence.

Our county has a serious drug problem, both legal and illegal. I did the UW training in the fall of 2010 because I felt that opiates are overused, don’t work well for chronic pain and I’d seen people get hooked. The UW’s head of the Pain Clinic, asked me why our rural hospital physicians and administration were refusing free training when they had offered it over and over.

I asked the administration of our rural hospital. Their reply consistently has been “None of our doctors want to do that training.”

I have asked multiple doctors and midlevels at our rural hospital. I receive one or both of two replies: 1. “The administration won’t let us.” 2. “I don’t want to take care of that sort of patient.” The second reply is clearly discriminatory and opens our rural hospital to the risk of a lawsuit.

I was the only provider in the county who could prescribe buprenorphine to opiate dependant patients from winter of 2010 until late 2013. I have a cap of 30. I also was not signed on to Medicaid until this year I am signed on with United Healthcare. Now both Dr. X and Dr. Y have the additional DEA number as well.

I want to know why our county hospital is not willing to take care of these patients. I think that the physicians and midlevels should go through the addiction medicine and buprenorphine training whether or not they are willing to prescribe buprenorphinne. I think that when the Centers for Disease Control has called this a US epidemic, it is incumbent upon our county to address this issue and make certain that providers are well trained. Of the three non-Jefferson Healthcare physicians who are willing to work with these patients, I am the only one who takes United Healthcare, and I am not yet approved for the other two Medicaids. So Our County has NO providers for this treatment of 2/3s of the Medicaid patients, which comprise our poorest and most disabled people under 65.

Your reply as soon as possible would be greatly appreciated.

Yours truly,

Lizardinlaw MD

Cc Hospital CEO
Cc Heads of Pain and Addiction Clinic

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