file, Star Tribune
Boogaard's death shows how easily patients can get pain pills
- Article by: Maura Lerner and Mike Kaszuba
- Star Tribune staff writers
- June 17, 2013 - 10:57 AM
Within days, Boogaard, the Wild’s 6-foot-7 enforcer, was bouncing from one team doctor to another seeking a steady stream of powerful painkillers. He got them — 165 pills in the first four weeks, 432 by the end of the season, according to a lawsuit filed last month by Boogaard’s family.
In court, the family blames the National Hockey League for not doing enough to prevent the tragedy that led to his death, at 28, in 2011.
But the lawsuit also sheds light on a problem that the medical profession is only now struggling to face: its own role in a drug-abuse epidemic that kills 15,000 people a year.
It started innocently enough, as doctors began an aggressive push in the 1990s to help patients control pain from injuries and accidents. But it morphed into “one of the biggest public health crises that we’ve faced in a long time,” said Dr. Patrick Courneya, medical director of the HealthPartners health plans. “And it was self-inflicted.”
Today, nearly 80 percent of the world’s prescription painkillers are used in the United States, said Carol Falkowski, former director of alcohol and drug abuse for the state of Minnesota. Nationally, 219 million prescriptions for those pills were written in 2011, she said — enough to medicate every man, woman and child “every four hours for a month.”
As the number of prescriptions soared, so has the death toll from accidental overdoses — an estimated 125,000 Americans in the last decade.
Now, the unintended consequences have become so alarming that the Minnesota Medical Association and other medical leaders are calling for a dramatic change in practice to cut the number of pain pills that doctors routinely prescribe.
Despite their best intentions, doctors have become too cavalier about handing out painkillers, said Dr. David Thorson, chairman of the Minnesota Medical Association. “We are overprescribing these drugs,” he said.
The Boogaard family’s lawsuit opens a window on how a young athlete became hooked on painkillers, and how he managed to feed his addiction by going from doctor to doctor.
And it hints at the challenges facing the medical profession.
Boogaard was known as an enforcer, the guy who roughed up opposing players on the ice. So when a fight broke out during a game against the Florida Panthers on Oct. 16, 2008, his broken tooth was just another occupational hazard.
Four days later, Boogaard got a prescription for 15 pills of hydrocodone — the narcotic in Vicodin — from Dr. Kyle Edlund, a team dentist, according to a detailed chart in the lawsuit. Three days after that, he got a prescription for five Vicodin pills from Dr. Sheldon Burns, the team medical director. The chart shows that Boogaard got at least 115 more prescription pain pills in the next 24 days from five team doctors or dentists, all but one explicitly for a “tooth injury.”
During that time, Boogaard even sought pills from an opposing team’s physician, Dr. Arthur Ting, who was once accused of writing painkiller prescriptions for friends and athletes under fake names. Ting, a team doctor for the San Jose Sharks, was still on probation by the California Medical Board when he authorized 40 pills for Boogaard, records show.
By September 2009, the lawsuit alleges, Boogaard was “addicted to these pain pills, often ingesting up to 10 per day.”
William Gibbs, a lead lawyer for the family, says the NHL was paying for the drugs and was “in the best position to know whether team doctors, dentists, medical directors, oral surgeons — what have you — were overprescribing prescription pain pills.” The NHL declined to comment, citing the ongoing litigation.
Edlund, the team dentist, disputed the account in the lawsuit, saying: “I actually never gave him any Vicodin at all.” He said he was not part of any system that freely gave medications to players. “If a player comes in with a legitimate broken front tooth, and it’s something that would cause pain in a normal person, then I would call the pharmacy and I might give [the patient’s] physician a call.”
Other team physicians who, the lawsuit says, repeatedly prescribed narcotics to Boogaard — including Burns, Dr. Joel Boyd and Dr. Daniel Peterson — declined to comment or did not respond to requests for interviews. “I don’t want to talk,” said Burns, who is also a team doctor for the Minnesota Vikings, Timberwolves and the Lynx. The Minnesota Wild also declined to comment.
Four years later, it’s not clear if team doctors shared a single medical record, which might have told them if Boogaard was “doctor shopping” for pills. But until recently, there was no way for most physicians to track that kind of practice.
That changed in 2010, when Minnesota created a Prescription Monitoring Program to track the use of controlled substances. Doctors and pharmacists can use it to find out if patients have filled similar prescriptions from other medical professionals. But it’s voluntary, and not all doctors use it.
“You’ve got to remember that these [patients] are very skillful at telling stories,” said Thorson, of the MMA. Physicians want to help patients who genuinely are in pain, “so we’re easily conned,” he said.
Decades ago, it was rare for doctors to prescribe such powerful narcotics, said Dr. Gavin Bart, an addiction specialist at Hennepin County Medical Center. “You [would] never give an opiate to treat pain unless people have cancer.”
But by the 1990s, that changed. Experts and drug companies started encouraging doctors to treat pain more aggressively. And patients started to expect it.
Dr. Marvin Seppala, chief medical officer of the Hazelden Foundation, likes to say that as a kid, he would have been “lucky to get an aspirin” for a sprained ankle. Today, a teenager hurts his elbow and gets 30 pills of Vicodin.
As a professional athlete, Boogaard “was able to get them with remarkable ease,” he said. But “the truth is, almost anybody can.”
Now, doctors are trying to put on the brakes. The Minnesota Medical Association has formed a task force to try to curb the use of the drugs.
And HealthPartners has started a campaign to rein in prescriptions one department at a time, Courneya said.
In a pilot study, the group’s hand surgeons cut the use of narcotics by 30 percent after they crafted new guidelines to use them more sparingly, according to HealthPartners. Now other departments are doing the same. “This has reached a tipping point,” said Courneya.
One big challenge, he said, is to figure out ways to shift chronic-pain patients to a “lower, safer dose,” or wean them off completely.
At the NHL, meanwhile, there are signs the Boogaard tragedy may be having an effect. The new players’ contract, signed in January, requires each team for the first time to designate one person responsible for monitoring the prescription drugs given to players.
“If we’re honest with ourselves, this is one situation where there’s enough responsibility and [blame] to go around,” said Courneya. “Most physicians and most patients are really just trying to do the right thing. And in this case, I think we wandered down a very dangerous path without realizing it. Now we have to find a way out.”
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