Libby doctor’s license suspended for over prescribing
http://www.nbcmontana.com/news/Libby-doctor-s-license-suspended-for-overprescribing/37139038.
The state Board of Medical Examiners has indefinitely suspended a Libby physician’s license after finding he overprescribed pain medication to a patient.
Another physician filed the complaint against Clyde Knecht in August after a former patient of Knecht’s sought treatment for her hydrocodone addiction.
The board says the complaining physician searched the Montana Prescription Drug Registry and found that between March and August the woman was prescribed nearly 2,500 doses of hydrocodone-acetaminophen.
Knecht told regulators that he had tried to refer the patient for treatment of her narcotic addiction. He also argued that prescribing narcotics was preferable to a dependence on alcohol or street drugs.
Knecht has 20 days to request a hearing. He did not return a phone call seeking comment.
Filed under: General Problems
Maybe someone didn’t understand the difference between addiction and physical dependence. Maybe someone’s family browbeat her into thinking she was addicted when she really wasn’t and that’s why she went to the doctor and made such a statement. Not knowing the original pain diagnosis makes it difficult to know if she was a legitimate chronic pain patient and this is a bogus complaint and should be dropped or an addict and the doctor should have gone with Suboxone therapy. Regardless, the Montana BOME will have their ‘witch hunt’ with this doctor
Instead of criminalizing this doctor, the best thing to do would be to discuss what would have been the best treatment for this woman. If I had been her doctor, I would have suggested tapering down the hydrocodone and replacing it with Buprenorphine. From what I’ve read, bupe helps to control the cravings, while also helping with pain levels. Of course, the doctor would need to be certified by the DEA to dispense bupe. And since this drug is being used to treat chronic pain, maybe all pain doctors should be certified, so at least they would have the option to prescribe this drug to certain patients.
Something without acetaminophen would have been preferable, but it looks like the patient was likely within acetaminophen dosing guidelines if taken AS PRESCRIBED. Since this person had trouble controlling medication usage, that’s not something that can be taken for granted. I realize that the DEA rules do not allow doctors to simply maintain an addict unless:
1) it is only for a limited period while other treatment is
arranged (usually 72 hours maximum).
2) they are being treated in a CSAT certified methadone
maintenance program.
3) they are being treated with buprenorphine / naloxone (or
buprenorphine monotherapy if pregnant or allergy to
naloxone exists) by a physician
with a DATA waiver (indicated by an “X” in front of their
DEA Registration Number.
However, many programs have extensive waiting lists. In a rural state like Montana treatment programs are few and distances may be great. Yes, this may technically be a violation, but I think that the Board needs to look at what options were available and whether they were viable in the given situation. They need to consider whether maintaining this patient on hydrocodone was in the patient’s best interest. Did it keep the patient from resorting to black market prescription drugs, IV drug use, heroin, and other dangers? Were the patient specific factors making withdrawal more dangerous? Lastly, it should be considered that this was a single patient. I don’t know the full story just reading the article from the newspaper, but I can only hope that the Board will investigate thoroughly and search for the truth while considering the physician’s intent, the patient’s bests interests, and any limitations in community support.
“2,500 doses of hydrocodone” in a 6-month period. Let’s break that down, shall we?
That’s about 14 pills per day. I was taking two Norcos every 4 hours, which is 12 pills per day. And that wasn’t the only prescription drug I was taking.
Yes, this woman was in danger of acetaminophen toxicity, but it is possible to get hydrocodone without acetaminophen.
I guess this doctor should’ve just abandoned his patient. Sure, that would’ve been the right thing to do. After all, that’s what law enforcement wants doctors to do.
And isn’t it interesting that another doctor was the one who turned him in? Hey, all you doctors out there, better watch your backs. Don’t anger your colleagues. Or you could find yourself in jail.
“He also argued that prescribing narcotics was preferable to a dependence on alcohol or street drugs.”
Again
“He also argued that prescribing narcotics was preferable to a dependence on alcohol or street drugs.”
Who better to control an addicts dependency than a physician? Unfortunately prescribing large numbers of narcotics once a month is not the answer and would more then likely have eventually become fatal. This doctor sounds like the true definition of a drug dealer with a license and it’s these types of physicians who are making our battle so difficult.
Why has it been so hard for policy makers and prescribers to find a common ground? I’ll tell you why, it’s because of doctors like this one. The so called professional who uses his vocation to enable a week persons habit. I mean look, Clyde Knecht admitted that he knew this patient had an addiction problem but just gave her more drugs. He says that he attempted to get this woman into a program and she refused, so he continued to write her prescriptions even know he knew it was wrong. Using the lame excuse that he just kept prescribing so she wouldn’t turn to street drugs is BS, if he really wanted to help this women, he would have reported her problem and done everything he could to help her. Maybe the board should look into what old Clyde really received for his services because it sounds like he wanted to keep her dependant, not only on the opiates, but on him as well.
This is where we do need regulations and I’m sure many of you would have to agree, but policy makers need to realize that not all prescribing physician’s are like good old Clyde. They also need to quit regulating by using scare tactics, in other words, stop threatening to take licenses away if you feel a doctor is over prescribing. They can’t take the actions of a few bad eggs and just assume that the rest of the pain community is the same way. I’m willing to bet that a huge majority of physicians will be willing to accept new prescribing guidelines if they are responsible and help their patients instead of hurting them.
Yes, I believe that this guy is a quack and he should be prosecuted for his crimes. I also believe that Investigators need to really look back at his records to see if there are others that he was enabling. Something tells me that they will, something also is telling me that the majority of the new ones they might find will be females.