Whenever police shut down a pill mill and lead a doctor away in handcuffs, Dr. Maulik Bhalani cringes. Not that he isn't glad to see the white-coated drug dealers caught. But as someone who is board-certified and fellowship-trained in interventional pain medicine, he worries that folks will equate all pain management doctors as scofflaws.
"I see the eye rolls when I tell people what I do," says Bhalani, who is affiliated with Florida Hospital Zephyrhills.
Bhalani wants to let those needing help know what a qualified practice looks like. Another goal is to make prescription drug education as common as DUI prevention in the schools and to help parents know when and how to intervene.
Bhalani sat down with the Tampa Bay Times recently to talk about these topics. Answers have been edited for clarity and brevity.
How do most people become addicts?
The sad part is a lot of them don't know any better. They go to a so-called "pain clinic" and they get caught in a trap. Doctors will prescribe what we call the "unholy trinity" of Oxycontin, Xanax and Soma. They'll get addicted in as little as a week and want to see the doctors again and again. They'll do anything to come up with $100 to go to the clinic again.
How did we get into this mess?
In the 1980s, pain was undertreated. In the 1990s, attitudes about pain changed. Pain was defined as a vital sign. Powerful painkillers were invented. And in the 2000s, physicians went from medical doctors to medical drug dealers.
Don't doctors make enough money practicing legitimate medicine? Why risk a medical license?
Do the math. Most offices spend 10 minutes per patient and charge $200 a visit. 200 times 50 equals $10,000 per day, times 263 days a year, equals $2,610,000 per year for the medical drug dealer.
How are teens getting access to these drugs?
The most common place is mom's and dad's medicine cabinet. Or grandma's nightstand. They'll grab anything. Old painkillers, blood pressure medicine. We've heard of "pharm parties" where they take the pills and create a "trail mix" by pouring them all into a big bowl. They call it "Skittling." They often use in conjunction with alcohol, making it even more dangerous.
Is this really happening in Pasco County?
My ER doctors tell me it has.
Are there any school-based programs to deal with this issue?
I'm working on a program modeled after one in Sarasota, where they talk about this in the high schools and let them know the degree of the problem.
What should parents do to make sure their kids don't get involved with prescription drugs?
Lock up their medicine cabinets. They also need to keep track of the number of tablets they have. If they suspect something, ask them. Talk to them. Because kids have easy access to them, they think of prescription drugs as a lot safer than other drugs.
If you do need a pain specialist how do you find a legitimate one?
There are some signs to look for. If a clinic takes cash only, it's probably a pill mill. Look around. If the majority of patients are under age 50, it's probably a pill mill. If there lots of coupons and discounts, it's probably not legitimate. I tell people that they're not going to get an oil change, they're going to see a legitimate physician. If all they want to do is prescribe controlled substances, it's a pill mill. I rarely write for oxycodone.
What do you do to control pain?
We use a multidisciplinary approach. We use ultrasound, physical therapy, epidurals, biofeedback. We also pull pill data on every patient who comes in. We know if they're doctor shopping. I know that's what a lot of patients come to see me for. We look and tell them, "you're on way too many meds. You need to try to a lot of other things." If they're not willing to do that, we won't accept those patients.