March 29, 2011 —     A patient on his way to the hospital asked the attending ambulance paramedic which doctor was on call in the emergency room. When the paramedic told him it was Dr. John Sanders, the patient said “Never mind. Just take me home.”

    “I’ve got a reputation for being somewhat hard when it comes to people drug seeking in the ER. There’s a population of patients out there who can’t stand me,” said Sanders of St. Claire Regional Medical Center Emergency Medicine.

    As an ER physician, Sanders said he daily sees patients in pain and feels compelled to help bring relief.

    “I am aggressively committed to helping people who are truly in pain. It’s my job to help them feel better,” Sanders said.

    Now in his fifteenth year at SCR, Sanders admits it can be difficult to make such distinctions between those in legitimate pain and those who are drug seeking to fuel their addiction.

    “It’s hard to tell sometimes, and it’s the hardest part of my job. The thought of sending someone away in pain hurts me,” he said.

    “But every day, I see people who are not telling me the truth about their level of pain and cannot prove what medications they’ve been prescribed,” he added.

    Sanders’ dilemma is one shared by many of his colleagues. The American Academy of Family Physicians found that physicians often undertreat patients with pain because of concerns about drug abuse. At the same time, they may fall prey to drug-seeking patients.

    The organization’s website expressed this dilemma as an “unfortunate paradox for physicians” torn between the desire to relieve pain, anxiety and other discomfort and “the fear of creating addiction, of being investigated, of being ‘scammed’ by the occasional patient.”

    Sanders said his years of experience at SCR, and working in hospice and pediatrics has helped him identify and relieve a patient’s legitimate and acute pain. He said the same experiences help him identify patients that may be using the emergency room as a pharmacy.

    “We see a lot of the same people over and over again, and I can usually spot the ones who are drug seeking. I make sure they’re not acutely ill or really in danger.

    “I tell them flat out, ‘I’m not judging you, I don’t think addiction is your fault, but I believe you are drug seeking and I’m not going to give them to you,’” Sanders said.

    The physician has seen patients go to great lengths to fuel their habit, from amputating fingers, purposely breaking an arm or simulating a kidney infection.

    “That’s a very common ruse people use to try to get pain meds from us. They prick their finger and put blood in the urine,” Sanders said.

    EMS Director Danny Blevins said his crew also regularly encounters drug seekers when ambulances are dispatched.

    “We have to treat each run like it’s the real deal, but during our assessments we may get the indication that a person is drug seeking,” Blevins said.

    “Our care has to be the same for all, and we trust the truth will come out in the emergency room,” he added.

    Dr. Sanders spoke of prescription drug addiction as grist for pill mill that drives addicts to doctor shop and seek meds through the ER.

    He’s seen addiction wreak havoc on individuals, families and systems in Eastern Kentucky.

    In 2009, Sanders was featured on “The Oxycontin Express,” a Vanguard documentary that chronicles the rise of Florida pain clinics and the steady flow of Eastern Kentucky traffic there.

    Sanders said the pill pipeline does account for how some of the patients he sees become addicted, who then resort to ER drug seeking. He said the solution does not involve him prescribing more pills.

    Instead, he talks to his patients about addiction as a disease, and about recovery through abstinence and 12-step programs.

    To those who argue that addiction should not be considered a disease, Sanders said he need only look at the similarities between it and others diseases.

    “I mean if you look at the symptoms of a person in addiction, you can clearly see the disease at work,” he said.

    “The behaviors, the changes in the body and in the mind all point toward a disease state. I think it’s really important that we understand that someone in addiction is sick, not bad,” Sanders continued.

    “To me it’s just like high blood pressure or diabetes. It runs in families and it’s deadly if it’s not treated properly. There’s treatment for addiction, just like for other diseases.”

    Sanders said he has recovery-oriented conversations with patients all the time and stresses that they cannot overcome addiction with willpower, fear or sanctions.

    “I tell them I believe in 12-step programs. Substance abuse is a symptom of what’s wrong with a person, and these groups can help you figure that out,” Sanders said.

    He said he also relies on the Pathways, Inc. Crisis Unit to come evaluate patients for substance abuse and mental health.

    Blevins said even a person who comes through the ER drug seeking is still someone who needs help.

    “Addiction is a medical issue too. They’re needing help and hopefully during the course of the evaluation they will get it,” Blevins said.

    Sanders said he’ll continue to use discretion when treating patients for pain, and that will likely still involve turning people away.

    “It would be easier for me to just give you the drugs, but I cannot. It’s just not the right thing to do because maybe me saying ‘no’ has been the impetus for a few people to get sober,” Sanders said.

    Watch a clip of the Vanguard program featuring Dr. Sanders by clicking here.

    Noelle Hunter can be reached at nhunter@themoreheadnews.com or by telephone at 784-4116.