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Amid Rural Doctor Shortage, Dozens Of Medical Workers Charged In Opioid Crackdown


A crackdown this week on opioid abuse resulted in federal criminal charges against 60 people accused of illegally prescribing and distributing opioids. They include doctors, nurses and pharmacists. One even allegedly traded drugs for sex. That sting focused on Appalachia, one of the areas hardest hit by the opioid epidemic. It's a mostly rural area where access to health care is already a challenge for residents.

So we wanted to know about the impact of this crackdown on both addicts and people who rely on opioids to manage chronic pain. That's something Dr. Stephen Loyd has been thinking a lot about over the last few days. He's based in Nashville. And he's the state of Tennessee's former assistant commissioner for substance abuse. He's also a former addict, and now works with addiction recovery programs in the Nashville area. Dr. Loyd, thank you for talking with us about this.

STEPHEN LOYD: Thanks so much for having me, Sacha.

PFEIFFER: More than half the people charged in the sting are from Tennessee, where you live. Seventeen of them are doctors. Give us some perspective on what happens when you remove 17 doctors and other health care officials from a rural area that already has a doctor shortage even if those doctors were doing criminal things?

LOYD: That's something that, you know, that I think we really need to consider because a lot of these areas have a hard time recruiting providers in the first place. And I ran into this in previous work that I had done against doctors and nurse practitioners who were improperly prescribing. And even in open-and-shut cases, it's very hard to remove those doctors from the community in front of the jury of their peers because they're the only health care sometimes, you know, for miles.

And so it is an impact on the community. And I think that a lot of consideration has been given to that by our state officials. But it is an impact because of the restricted access to care, even if they are bad providers when it comes to prescribing controlled substances.

PFEIFFER: Well, and the reality is that some of these health care professionals who were charged will probably not be able to practice again. That really impacts people who relied on them to get opioids to manage chronic pain. What are the options for those patients now?

LOYD: There's only so much you can do, Sacha, right? You can direct them towards another health care provider. But a lot of times, we're talking about, you know, certified legitimate pain medicine doctors - which I can tell you, there are not enough of in our state, and certainly aren't enough of in rural Appalachia - and then those people with addiction, you know, the people who, you know, who have been feeding their addiction through these illicit prescriptions. Legitimate addiction medicine doctors that are going to utilize evidence based practice, there is a shortage of those as well.

Now, if we're talking about state agencies and state funded agencies that, you know, such things as the 21st Century Cures Act money that came down a few years ago initiated by President Obama and then, you know, followed through on with President Trump, that's really good access to care. And my state's done a great job with that. But the problem lies outside of their control, right? Because now we're really talking about the stigma associated with chronic pain patients as well as patients with addiction disease, and therein is the underlying problem.

PFEIFFER: In terms of how to help people who've lost their doctors in this sting, the Tennessee Department of Mental Health and Substance Abuse Services has publicized two hotlines that people can call to find treatment services or counselling. And they say they're offering more training sessions to teach people how to use naloxone, the overdose reversal drug. Do you think that's enough outreach?

LOYD: I think it's a great response, right? It's a great initial response. But I want you to think of it from a patient standpoint, and that's where I come from. So - because I work in this everyday and I see the mindset - so it takes a lot to pick up the phone and call a hotline. And then, you know, being directed from care there, there's a lot of follow through that has to happen. And there's some folks that won't do that for a lot of reasons. And so a lot of times, the easier alternative is is to seek it illicitly. So is it enough? No, I don't think it's ever enough. But I don't think it's anything that state agencies can control right now.

PFEIFFER: So if, as you say, this crackdown could result in people just looking elsewhere for drugs, maybe illegal drugs, what has been accomplished?

LOYD: Well, you have to take players like this out of the business. This is one of the things that frustrates me right now. The pharmaceutical industry points to now is, OK, we're not talking about prescription pills anymore, right? We're talking about illicit heroin and fentanyl. But people got started seeking heroin and fentanyl from the prescribing of those pain medications coming out of clinics like this. You absolutely have to cut that off.

The response will be what - where the key is in how we direct people to help.

PFEIFFER: So crack down on the doctors, but make sure there's a support system ready for their patients.

LOYD: Absolutely. And the thing is - and this is so beautiful - is that when you get to watch lives change. For myself, you know, I used to get up every single morning thinking, you know, where am I going to get my pills? And that occupied my entire day. Now, keep in mind, I was a practicing physician. So I had some other things to do. And that's what people who are, you know, who are addicted are facing every single day.

And now, you know, providing them with quality help and watching them change their lives is one of the most fun things that I've ever been involved with. We need to make that opportunity more widespread. We need to decrease the stigma around stepping out and ask for help. And also, Sacha, we need to make evidence-based treatment available without the stigma that goes along with it.

PFEIFFER: That's Dr. Steven Loyd. He's based in Nashville, Tenn. Thanks for talking with us.

LOYD: Thank you. Transcript provided by NPR, Copyright NPR.