Prescription for Disaster: The Search for Answers

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CLEVELAND - When you watch Alex Forde, 15, run on a treadmill, or do push-ups, or stretch his back, it's hard to believe he had to be taken around in a wheelchair just three months ago because he was in so much pain.

"You can do something about your pain and... your pills aren't your only weapons against the pain," he said.

Forde, who is from Maryland, came to the Cleveland Clinic for help with both the source of his pain, a neurological disorder, and the pain itself.

"We feel incredibly optimistic," said Alex's mom, Gail Bernstein, "that he has gotten his life back without the need for anything like a narcotic or an opiate."

As Ohio battles an epidemic where overdoses have now passed car wrecks as the state's number one accidental killer, Alex's story illustrates where part of the answer to the problem may be.

But every expert agrees there is no "magic bullet" - that the problem requires a number of approaches if the state is to reverse an increasingly deadly trend.

The number of deaths from overdoses has exploded in just over a decade.

In 2010, 1,544 people in the state died from an overdose - compared to 327 back in 1999.

"I think the docs have a big responsibility to deal with this," said Dr. Michael Anderson, the Chief Medical Officer for University Hospitals and Case Western Reserve University.

One of the issues is that doctors in the state have increased the number of opiate prescription pills they write by almost a thousand percent over the last fifteen years.

Experts say the increased number of deaths tracks the increased number of prescriptions written.

Dr. Anderson said that's why UH has developed a brand new policy designed to help doctors prescribe opiates more correctly.

The policy includes guidelines on how the doctors should follow-up with patients, and, importantly, how they can look for alternatives to prescribing these addictive medications.

Still, Dr. Anderson said physicians face their own catch-22.

"We don't want our patients suffering pain," he said, "and on the other hand, we don't want them to get 'hooked' if you will. So that's why we think our guidelines are at least a starting point."

Another issue is that people who start on prescriptions often migrate later to heroin.

Between 2006 and 2011, over 400 people died of heroin overdoses in Cuyahoga County - 235 of them in Cleveland alone.

That's why experts say treatment is critical.

"If you just stop a given drug," said Cheri Walter of the Ohio County Behavioral Authority, "people with an addiction will just switch to another drug."

People in the medical field also have questions about how the state and federal governments plan to respond.

Many doctors fear that the federal government will soon tie how much physicians get paid for taking care of Medicare or Medicaid patients to so-called "satisfaction surveys." 

The concern is that if they don't give some patients opiates, those patients would rate the doctors lower, and the doctors would get paid less.

In response to questions from Fox 8's I-Team, the Center for Medicare and Medicaid Services said it is in the "early stages" of determining quality measurements.

CMS said the government will work to make sure the payments do not have "unintended adverse consequences" for either doctors or patients.

Meantime, some advocates have expressed concern that Governor John Kasich's administration is proposing a cut in funding for drug treatment services.

A spokesman for the governor acknowledges that one particular program is facing a cut that totals $2.8 million statewide.

But the governor's office tells the I-Team the state is taking some responsibilities on its shoulders that used to belong to local agencies - which, it says, will free up $15 million statewide to be used on the local level as officials see fit.

The spokesman says overall funding of these types of services is now being increased 6.8% in what is a tight state budget.

Judge David Matia, who runs the Cuyahoga County Drug Court, said treatment costs taxpayers about $5,000 a year per patient, whereas putting someone in jail cost about $25,000 a year.

"Treatment is not being soft on crime," Judge Matia said, "it's being smart on crime."

And part of the answer may well be what Alex Forde is learning - a new way for people to approach pain.

"What I like to tell kids and families is to think about pain as pain, but know that suffering is optional," said Dr. Gerard Banez, the pediatric psychologist for the Cleveland Clinic who runs the program where Alex is a patient.

So, for example, patients sometimes can't sleep because of pain, but if they can exercise through the pain, they can get tired enough to fall asleep - which, in turn, can help them feel better.

"It was hard to believe that the Clinic's philosophy actually worked," says Alex's mom, Gail. "Hard to believe that you have to get your life back before you can deal with your pain."

"I don't often use the word 'miracle,'" Gail continued, "but I've said to Dr. Banez that, for us, this feels like a miracle."

This type of treatment won't be the answer for everyone that it has been for Alex.

But it is a start.

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