When Drug Treatment For Narcotic Addiction Never Ends : Shots - Health News Medicines that help users wean themselves from opioid drugs can be prescribed in a doctor's office or clinic. But some clients question whether the clinics always have their best interests at heart.
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When Drug Treatment For Narcotic Addiction Never Ends

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When Drug Treatment For Narcotic Addiction Never Ends

When Drug Treatment For Narcotic Addiction Never Ends

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We're going to explore a big loophole in a controversial new law. In Tennessee, mothers can be charged with a crime if their babies are born dependent on drugs. The crime is called fetal assault. We've been reporting on it all week. But here's the loophole. Anybody taking these drugs with a doctor's prescription cannot be charged, no matter where the prescription comes from. And it turns out, it is really easy to get a prescription.

BLAKE FARMER, BYLINE: Yep, parts of the state are full of clinics that people call pill mills.

SHAPIRO: That's Blake Farmer of member station WPLN, my reporting partner on this project. And, Blake, explain what you mean by pill mills.

FARMER: Well, that's what law enforcement calls them. And they're actually referring to two different kinds of things. First, there are so-called pain clinics where people can go, say they have back pain and get a prescription for a powerful drug like OxyContin. And then there are so-called treatment clinics which offer to help people addicted to those powerful drugs. They prescribe drugs like Suboxone and Subutex, which are a standard treatment for addiction. Those drugs are used to manage withdrawal symptoms, but they can also be abused.

SHAPIRO: And you visited one of those treatment clinics. Describe this place for us.

FARMER: OK. We're in far, rural, Northeast Tennessee. It's this Civil War-era cabin. On the front, you've got two doctors' names and the word addictionology.

SHAPIRO: Wait. Is that actually a word?

FARMER: You know, I'd never heard it, but I looked it up. It is a word. So this place - it's next to a DMV. And all of a sudden, a guy walks out from behind the building. He says, well, there's John. And that's how I met John Fisher, who runs the clinic. A bit to my surprise, he welcomed me in, even with my recorder going.

So are you a licensed counselor or something like that?

JOHN FISHER: No, no. I spent 20 years perfecting the skill of addiction and consequences and 24 years in recovery. And all I'm taking is what I learned on both sides of the fence. That's why I can relate to anybody that walks in here and understand where they're coming from.

SHAPIRO: Blake, explain exactly what goes on here at this clinic.

FARMER: Well, this clinic advertises itself as a treatment center, and there are two doctors who work here. John Fisher told me they try to treat people's addictions with drugs like Subutex and Suboxone. But breaking an addiction like this can take months, maybe years. And in the meantime, places like this can make a lot of money.

Today, Fisher's making coffee for a group therapy session that's about to start. He requires everybody who gets prescriptions here to attend these regular meetings. He spills the coffee.

FISHER: Paper towel time.

FARMER: His hands shake as he cleans up the water. He admits he's nervous because his business model sounds suspicious. People pay $500 for a five-week prescription. And this is a really poor area, so some patients turn around and resell part of their dosage on the street to make money for the next round at a clinic.

Do you take insurance here?


FARMER: Why not?

FISHER: Because most of them do not have insurance.

FARMER: It's so interesting to me that just straight out, you admit it. Our appeal to them is that they can get a prescription here.

FISHER: Yeah. So I use the medication as fishing bait. What I do is bring them in, and we taper them over a period of time.

FARMER: And what of folks who look at this, whether they're right or wrong, and say, well, you'll just have your little business going here, and you're selling drugs?

FISHER: Exactly. That's what we hear. I invite them to come sit. I've even sent letters out, invited local officials. Come sit in group.

FARMER: The doctors who actually write the prescriptions were not there when I visited, so I followed up with one of them a few days later. Dr. Mack Hicks told me he understands why people would be weary of his clinic, but he defended his work, saying he's just trying to help addicts.

MACK HICKS: If someone wanted to shut them all down, all the Suboxone clinics, all the Methadone clinics, what do you think that would do in terms of all the people that are addicted? You know, that's not going to cure the problem.

FARMER: Now, folks at this clinic say they try not to take pregnant women as patients, but other places like this do. Tiffany Hall learned this firsthand. She was a nurse in a neonatal intensive care unit. She treated babies with drug dependency. And then she gave birth to twins who went through the very same thing. Turns out Tiffany was an addict herself.

TIFFANY HALL: The babies withdrawal just like an adult would. You stand there, and you watch your own child go through something you're not willing or wanting to go through yourself. And you have to stand there and watch it knowing that you did that to them. And it's awful.

FARMER: When Tiffany got pregnant, she was addicted to OxyContin. She was smart enough to know that she could go to jail if her babies were born dependent. So she went to a place like the one I visited.

HALL: I ended up going to a Subutex clinic. And I thought, I'm OK now that I'm on Subutex. I have a legal prescription. If the babies withdraw, it's all right because it's legal - still wasn't thinking about anybody but myself.

SHAPIRO: Blake Farmer, you and I spent a week researching this law in Tennessee. And this just seems like a huge loophole. I mean, the law prosecutes mothers for using drugs during pregnancy but not if they're using them with a doctor's prescription, no matter where the prescription comes from.

FARMER: Exactly. And nearly three quarters of the babies that are being born with drug withdrawal symptoms are born to women with a doctor's prescription. So it's a real hurdle to try to solve this problem with a law like this one in Tennessee. And, Ari, as you know, this is just one of the complicated reasons prescription drug abuse has become this epidemic in parts of the country.

SHAPIRO: Blake, how are pregnant women or anyone, for that matter - how are they supposed to get clean when prescriptions are so widely available?

FARMER: I know. I wondered the same thing. Tiffany Hall, well, she's now going through a cold turkey program called Families Free. We stood outside the counseling center as she smoked a cigarette.

HALL: I think that's a pill mill next door - yeah, pretty sure.

FARMER: What is it like that there is a place next door that you know you could walk in right now and get a prescription?

HALL: For me, it's accountability. Yes, it would be easy to go next door and come up with some kind of story to get whatever I may want, but I have to be able to hold myself accountable and say no, I'm done with that. I don't want to do that anymore. So I like having it there.

SHAPIRO: Blake, you and I met so many women in Tennessee who were facing jail for using drugs without a prescription while pregnant. Is anyone facing punishment for prescribing these drugs so widely, including to pregnant women?

FARMER: Well, no is the short answer. But the same district attorney who really pushed for this fetal assault law also wants to see tougher laws regulating what he calls pill mills. And the state's already begun tracking doctors who prescribe more than their fair share of high-powered narcotics. But very few get in trouble because, frankly, what they're doing is legal, even if it sounds a little fishy.

SHAPIRO: That's Blake Farmer from member station WPLN in Nashville. Great working with you.

FARMER: The pleasure is mine.

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