Ohio man’s morphine needs caught in pain-pill crackdown

http://www.dispatch.com/content/stories/local/2016/09/14/state-probes-of-mans-huge-morphine-doses-scare-off-prescribing-doctor.html

MIDDLETOWN — For more than 20 years, Kevin Morgan has been a prisoner of his pain.

Just to get out of bed and hobble with a cane, Morgan requires as much as 70 times the amount of painkiller a doctor would normally prescribe. The normal average is the equivalent of 80 to 120 milligrams of morphine each day. Morgan takes almost 5,700.

“It’s enough to kill an elephant,” said Konrad Kircher, Morgan’s attorney.

Those massive amounts of painkillers caught the attention of government agencies. When officials see such high doses prescribed, they become suspicious that the drugs might be going to an addict or a dealer. Investigations led Morgan’s pain-treatment doctor to drop him as a patient out of concern that he could lose his medical license.

Now, Morgan is tired of the pain, tired of fighting the bureaucracy and, at times, tired of fighting to live.

“They told me I’d only live to 37, 38 years of age,” Morgan, 51, said between heavy breaths as he sat slumped on a couch in his Middletown home, barely able to lift his chin from his chest because of pain. “I have no quality of life.”

Morgan requires those ultra-high opioid doses, three doctors determined, to cope with the pain after a 1994 horse-riding accident. The horse that Morgan was riding fell on him, rolling over him. Then it stomped his head several times, leaving Morgan , who was 29 at the time , an “incomplete paraplegic” with little feeling from his mid-chest down. He stayed in a hospital bed and wheelchair for seven years and was told he’d never walk again.

His case, supporters say, is such an exception that something needs to be done to help him, even changing the law.

Before the horse stomping, the Middletown man was a paramedic and a small-business owner. He was so concerned about his southwestern Ohio community that he became a special Butler County deputy sheriff — a state-certified volunteer who helps other officers with tasks such as traffic control.

The horse’s hooves damaged his brain’s pain receptors. That, combined with genetic defects, causes Morgan to need massive doses of painkillers.

That is “much higher than any I’ve personally heard,” said Rep. Stephen Huffman, R-Tipp City, who is a physician but who had never heard of or examined Morgan.

Dr. Forest Tennant has. He is the California pain-medication expert who has examined Morgan several times and concludes that he is a “tragic and rare patient.”

“Frankly, we get a case like this once every 10,000 patients,” Tennant said.

Tennant was so intrigued by Morgan that he tested him twice. Each time, he gave Morgan a blood test to determine what drugs were in his system. Hours later, he watched as Morgan took his medication. Then he gave Morgan another blood test. It showed that Morgan’s body properly absorbed the medication, but it did not make him high. Instead, he remained lucid and able to cope with pain.

“I don’t know if you would call it a life,” Morgan said. “When I think of life, I think of being able to function, being happy, not feeling like a prisoner.”

The State Medical Board of Ohio, the State Board of Pharmacy and the federal Drug Enforcement Administration all investigated. They concluded that Morgan was taking all the medication and not abusing it.

“There’s a difference between a drug addict and being drug-tolerant,” Morgan said. Without the medication, he said, the pain can become so severe that he has seizures.

Extremely high prescribed doses are unusual, but in extremely rare circumstances, they “may be legitimate,” State Medical Board spokeswoman Tessie Pollock said.

Morgan’s original pain doctor, Tim Smith, agreed to surrender his medical license in 2013 after the State Medical Board said he inappropriately prescribed high doses of controlled substances and failed to properly document treatment for some patients. Because the patients weren’t named publicly, it’s unclear whether Morgan was among the 12 whose cases the state cited.

Morgan’s second pain doctor, Thomas Knox, then treated Morgan, but again state regulators noticed the high doses of opiates. Under Knox’s treatment, Morgan again submitted to tests conducted by Tennant, who again found that despite the high doses, Morgan wasn’t selling the drugs or using them to get high.

“He has to take a gallon in order to make a pint work,” Tennant said. “He’s very open about everything. He’ll take a urine test or blood test whenever and wherever you want.”

Knox tearfully told Morgan, who has never been arrested, that he could no longer treat him for fear of losing his license.

Ohio law and privacy rights prevent the government agencies involved from discussing Morgan’s case even though Morgan signed a consent form allowing release of his medical information.

Knox cooperated with state investigations and produced documentation of his treatment of Morgan, but “repeated inquiries” by both the State Medical Board and the State Pharmacy Board made the doctor think that if he didn’t drop Morgan as a patient, the investigations could end badly.

“If it becomes a threat to your practice, tough decisions have to be made,” said Daniel Zinsmaster, Knox’s attorney. “It was a decision made reluctantly and, I think, with sadness. I think his desire would have been to try to assist Mr. Morgan.”

Knox, ironically, at the time was a contract worker for the State Medical Board on pain management, including examining allegations of over-prescription of painkillers. After the state investigated Knox, it canceled his contract.

Morgan’s attorney and Tennant believe that the patient is caught in a bureaucratic morass because officials saw doctors over-prescribe medications through “pill mills,” and doctors now are wary of being accused of over-prescribing.

The result is a life that Morgan isn’t sure is worth living even when he gets the medication.

“It feels like a buzzing and a constant stinging that never stops, to the point where I go three, four days and I don’t eat, even with the pain medication,” Morgan said.

Kircher, who is representing Morgan for free, isn’t sure the case merits a lawsuit. He prefers a change in Ohio law to address rare cases such as Morgan’s.

“The goal is to create exceptions,” Kircher said. “Kevin can be the example for people who have slipped through the cracks. The only goal is to get Kevin the treatment he needs.”

Tennant suggested a law to appoint a few physicians to handle cases such as Morgan’s — to ensure that drug addicts or dealers aren’t tricking the system but that those who genuinely need high doses to survive get them.

“I don’t know another way out for him,” Tennant said.

Huffman, the state legislator and doctor, isn’t sure such legislation is necessary because the State Medical Board has stringent requirements for reporting.

“I think it’s a very unfortunate situation,” Huffman said. “It has to be frustrating for the patient.”

Morgan won’t say how he is getting his pain medication, but he said he has spent $80,000 on it since his doctor stopped treating him nine months ago. Now, he’s broke and doesn’t know what to do.

“This state has done everything but put me in a coffin and nail the nails in there. I have nothing to hide,” Morgan said.

“I did nothing wrong.”

 

Filed under: General Problems