American Greed

The American Greed Report: The deadly trap of opioid painkiller addiction

Americans are in a lot of pain. One in 4 adults surveyed by the Centers for Disease Control and Prevention said they had suffered a daylong bout of pain in the past month. One in 10 said the pain lasted a year or more. And anyone who has suffered chronic or acute pain knows you will do almost anything to get rid of it.

That makes pain a potential gold mine for drug companies that develop effective remedies, but also for unscrupulous doctors willing to exploit their patients' desperate need for relief.

Patrick Couch and Xiulu Ruan were two such doctors. Both are in prison after a federal jury in Alabama convicted them last year in a wide-ranging conspiracy to illegally prescribe highly addictive opioid painkillers in exchange for kickbacks from drug companies.

Top executives of one of those drug companies, Insys Therapeutics, have pleaded not guilty to charges they paid those kickbacks and bribes. The company itself was not charged criminally, but Insys is battling lawsuits by multiple state attorneys general claiming it helped fuel the nationwide opioid addiction crisis, which the company denies.

Opioid overdoses kill more Americans per year than breast cancer, according to the U.S. Department of Health and Human Services. President Donald Trump has declared the opioid epidemic a public health emergency, and on Thursday, Attorney General Jeff Sessions ordered the Drug Enforcement Administration to look at ways to restrict the levels of opioid production.

In a story told on the next episode of CNBC's "American Greed," Couch and Ruan wrote thousands of prescriptions through their Alabama pain clinic for the Insys drug Subsys, a spray form of the opioid drug Fentanyl, which is 50 times more potent than heroin. The FDA had only approved Subsys for late-stage cancer patients. But Couch and Ruan were prescribing it for patients with all kinds of pain. Many spiraled into addiction; several died.

While the role of doctors and drug companies in the opioid epidemic is still the subject of some debate, the case of Couch and Ruan points to a hard reality for pain sufferers. In your search for relief, you must also search for a practitioner who will not make things much worse.

Not-so-great expectations

Dr. Christopher Gharibo, a pain specialist at NYU Langone Health in New York, says it is important for patients to be realistic about what pain therapy will achieve.

"Your doctor can't eliminate your pain," he said. "You're probably still going to have some degree of mild to moderate pain. Your doctor is there to take away a considerable part of your pain, but they cannot eliminate it."

To maximize the potential effectiveness, come armed in your first visit with as much information about yourself as possible.

"Bring up your other medical problems and whether you had surgery in the painful area, for example, neck surgery, spine surgery, lower back surgery, hip replacement, knee replacement – all of that is very important information," Gharibo said.

Be prepared to tell your doctor about any other medications you are taking — both prescription and over the counter — as well as the dosage. And let him or her know whether anything has or has not worked in the past if the pain is recurring.

Opioid alternatives

The addiction crisis has already led doctors to cut back on prescribing opioids. When they do prescribe them, they do so for much shorter periods of time than they once did.

"Now a typical prescription tends to be, for chronic pain, about a month or so," Gharibo said. "That used to go month after month and sometimes for many years."

But he acknowledges that dependency can develop in as little as two weeks, which helps explain why doctors and patients are increasingly viewing opioids as more of a last resort for pain, and looking more seriously at non-opioid treatments.

"A foundation of therapy needs to be tried that is comprised of non-pharmacological therapies, physiotherapy, proper body mechanics, proper posture, what to do, what not to do, taking care of your body, weight loss, proper diet; over-the-counter medications," Gharibo said.

If none of that works, and if there is no success in addressing the underlying disease, there still may be alternatives to opioids.

"You could consider getting, for example, a trigger-point injector with local anesthetics, or a nerve block of some kind that can ... address the pain without putting on a daily dose of opioids or non-opioids or any medication therapy," he said.

Even if the treatment escalates to controlled substances — opioid or not — moderation is key. Where in the past doctors might have simply tried raising the dosage if a drug does not work, now they are rethinking that strategy when it comes to painkillers.

"If they're failing, it doesn't mean we go up and up on the dose," Gharibo said, "but we should be switching to another controlled substance potentially to try to capture the pain."

If your doctor is not being careful in that way, ask him or her why not, and consider asking for a second opinion.

Don't heal thyself

If you are not getting the relief you need, do not attempt to take matters into your own hands.

The American Academy of Pain Medicine offers a set of safety principles for patients and caregivers who are dealing with opioids. They include:

* Never take an opioid medication that is not prescribed to you.
* Never adjust your own doses.
* Never mix the medication with alcohol.

It is also important to know yourself, and be honest. Gharibo says some patients are more susceptible to addiction than others.

"A younger patient has a higher probability of getting addicted," he said. "A young male, for example, (more) than somebody elderly. Patients with a history of psychiatric disorders, patients with history of anxiety, past addictions and past controlled substance use, history of tobacco – all those are potential predictors of addiction."

If any of those descriptions apply to you — and even if they do not — be careful about agreeing to be treated with an opioid painkiller.

Couch and Ruan counted on patients who were so desperate for relief that they would not ask the right questions. The result was untold pain for victims and their loved ones.

See how crooked doctors Patrick Crouch and Xiulu Ruan turned their patients' pain into unspeakable heartbreak, on an all new episode of "American Greed," Monday March 5 at 10 p.m. ET/PT only on CNBC.