Concerns about abuse or overuse of opiate painkillers has recently led the Centers for Disease Control and Prevention (CDC) to come out with strict new guidelines to reduce prescribing. Also, just a little over a year earlier, the Drug Enforcement

Administration (DEA) rescheduled the commonly prescribed hydrocodone (Lorcet or Vicodin) from a Schedule 3 to a Schedule 2 drug, the highest level of control and scrutiny.

With the changes patients can get fewer pills at one time, there are more restrictions on refills – such as not being able to call them in – and pharmacies must follow stricter procedures. While the intention of the rule change is to prevent misuse and\or overdose deaths, pain specialist Carl Covey, MD, medical director of the Pain Treatment Centers of America in Little Rock, said there could be harmful consequences.

“Primary care physicians are just downright scared of any opiate medicines, and it is going to get worse with the new CDC guidelines,” Covey said. “Many won’t prescribe opiates, or if they write them, will write them for only three days. They will try to get patients to take aspirin or Tylenol, but you would be surprised how many people can’t take these. And many people are at risk from taking too much Tylenol. For a lot of these folks, opiates are the safest medicine. Primary care doctors do not need to fear taking good care of patients. They just need to be smarter and more careful about the volume of medicine they prescribe.”

Covey said when a patient comes in and is suffering, physicians need to help them by being a mentor, giving good advice and prescribing the appropriate medicine.

Opiate pain medicines work very, very well and are very safe from a toxicity standpoint, Covey said, so patients shouldn’t be denied the medicine because a small percentage of people will develop a psychological addiction to the medicine. And care needs to be taken to prevent a patient becoming ill from suddenly stopping opiate painkillers because they can no longer get a prescription.

“Even if you have been on an opiate painkiller for just a few days, it is important to taper off of it,” Covey said. “Don’t suddenly stop the medicine because you will feel really crappy. Always taper off just like with benzodiazepines and steroids.”

Another misconception is that people who abuse or overdose on painkillers are patients. The vast majority of those people are non-patients who are stealing the medication, obtaining it fraudulently, or buying it on the street. Covey said the vast majority of patients are using these medicines because they need them, and have never had a problem with addiction in the past nor will they in the future.

He recommends good judgment in writing prescriptions. Don’t write more than needed just because you don’t want patients calling back for a refill.

“Even good patients don’t know what to do with leftover medicine,” he said. “A lot gets stolen out of the medicine cabinet, or given away to someone who has pain. The medical community is trying its best to reduce this volume of unnecessary medicine without harming the huge number of people who not only need these medicines, but benefit greatly. You have to exercise good medical judgement. It is a very, very thin tightrope we walk between taking good care of suffering patients and not putting some medicines out there that a 16 year-old takes to a party and somebody dies.”

You can take wonderful care of many, many patients, and all it takes is one fraudulent patient getting medicine and it makes everyone looks bad.

“You have to be really careful,” Covey said. “One prescribing mistake nullifies 100 good decisions. Doctors must be much more careful sorting out the rare people who scam the system because it makes us all look bad. Arkansas has developed the Electronic Prescription Drug Monitoring Program, which is a wonderful tool to do this. We are slowly but steadily getting better.”

Another important piece of advice is to be careful about treating symptoms. Make sure to know what the source of the pain is rather than just masking it. For example, for someone with muscle spasms, sometimes it is better to treat the spasms than the pain. If pain is caused by inflammation, anti-inflammatory medicines might be a better choice than something like hydrocodone that blocks pain receptors in the spine.

“You are addressing more the source,” Covey said. “But for a huge population of pain patients, it is not inflammation nor is it correctable, even with multiple surgeries. Their pain is incurable. The vast majority of chronic pain patients are incurable, but manageable. That is why we call it pain management.”

Covey’s patients sometimes call him “the wizard” because he is the man behind the curtain. He believes it takes a good partnership with patients to address their chronic pain so they can go about their lives as normally as possible.

A big part of what he does is not just take care of the patient’s symptoms, but to protect their integrity because they are constantly questioned by family, primary care doctors, and pharmacists. Patients need to make sure they don’t allow their medicines to get stolen or take additional pain medications for another condition without notifying their physician.

“I have to protect your integrity, so don’t do things that make it hard to do that,” Covey said. “Always call. Always ask.”

Covey grew up in western Benton County in Gentry. He got his undergraduate degree at the University of Arkansas Fayetteville in industrial engineering and spent two years working as a computer system analyst for Honeywell before deciding to attend medical school.

“Working in engineering is mostly dealing with machines, devices, plans and paperwork,” Covey said. “I really enjoy dealing with people. My grandfather was a family practice physician in Paris, and his grandfather practiced medicine in Fort Smith. My mother and grandmother both told me I ought to be a doctor someday. I enjoy the science of medicine, so I went to med school and ended up in anesthesiology.”

He practiced in Fayetteville for 15 years, founding the Pain Clinics at Washington Regional Medical Center and the Northwest Rehabilitation Hospital before moving his practice to Little Rock in 1997.

Covey is a self-described “tinkerer.”

“I tell people my day job is a doctor, but I’m really a carpenter,” he said. “I like to build things. My wife, Paula, and I have been married 43 years. We have a cabin in Northwest Montana. Paula is a VIP chef for Verizon Arena banquets. She really enjoys that, and I enjoy eating her food. We have a couple of grandkids here close, and we love to play with the grandkids. I’m just an old country boy. I like simple things.”

To learn more:

Arkansas Electronic Prescription Drug Monitoring Program

CDC Injury Prevention & Control: Opioid Overdose

US Dept. of Justice Drug Enforcement Administration Office of Diversion Control

The New England Journal of Medicine “A Proactive Response to Prescription Opioid Abuse” 

Office of National Drug Control Policy, 2015 National Drug Control Strategy