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“For me, my own personal stories of opioid patients come to mind, including one who keyed my car when I stopped prescribing his opioid after an acute injury. I think of some local opioid overdose deaths in my community. I would love to hear what other doctors and clinicians have to say about these issues, like the ‘not responsible’ verdict and the Sackler family running away liability-free and still worth billions of dollars. Does anybody feel like the opioid companies were pushy in the ‘90s and 2000s? Were they in the right? Is the California ruling in line with the common good? Are our prescribing practices under scrutiny? What runs through our heads right now, doctors? I would love to know.”
Rebecca Thaxton is a family physician.
She shares her story and discusses her KevinMD article, “The people vs. opioid pharma: Pharma wins again.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Rebecca Thaxton. She is a family physician, and she wrote the KevinMD article “The people vs. opioid pharma: Pharma wins again.” Rebecca, welcome to the show.
Rebecca Thaxton: Thank you, Kevin. I’m delighted to be here. Thank you for hosting me.
Kevin Pho: So we’ll get into your article a little bit, but first off, can you share your story and journey to where you are today?
Rebecca Thaxton: Absolutely. I was born and raised in the southern West Virginia coal fields, and I still live in West Virginia, and I practice as a physician here. So I grew up, I guess, in the zeitgeist of the coal mining community, the coal mining culture, so I’m very familiar with the coal mining culture. That is pertinent to this particular article, because the southern West Virginia coal fields are an epicenter of this opioid epidemic.
So the first part of my background: I’m a physician, as are most of us here, and so of course I’ve seen and treated some pain medication patients, some work injuries, incidentally coal mining injuries, very traumatic work injuries, and some of them opioid-requiring. And I also now work for a very large company, and sometimes in my work tasks the companies will give me a case to review for them, for instance, an opioid maintenance analgesia case. So I will review the case, put that against the guidelines, CDC guidelines or any particular jurisdictional guidelines, and then give them a report back saying whether or not it appears to be a legitimate use of the opioid maintenance analgesia or if it’s a red flag. So that’s kind of the second part of my background.
The third piece to the puzzle is my brother is a lawyer who is deeply involved in the opioid multi-jurisdictional mass litigation. So I have gained a great deal of insight in some conversations with him, and hopefully I will be able to share some of that insight with fellow physicians.
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Kevin Pho: So we’re going to get into the article a little bit, but I want to hear what it’s like to treat the coal mining community. What are some of the unique challenges that you face as a physician?
Rebecca Thaxton: Early in my career, I used to see a lot more workers’ comp patients, and a lot of that involves coal mining injuries. And with coal mining, there is even more than just me as a particular physician, or individual physicians. It’s kind of the whole scope of the problem, as far as the coal mining culture.
The coal mining industry is a very dangerous industry. There are lots of very dangerous jobs. Coal mining is unique, and it’s kind of mystical and kind of romantic, because you do this tough labor job, and you go three, six, nine miles underground to perform it, sometimes in complete darkness, sometimes in tunnels where your nose is right at the seam, and sometimes you’re lying on your back and you’re in a very small tunnel. And you’re underground; you’re hidden from the public. So it’s its own environment. It’s a unique community, and it’s not open to the public. Nobody else sees it. Nobody sees the camaraderie and the community down there.
And it’s a community where coal mining, when I was growing up, was a more thriving industry than it is now. And coal mining, as all jobs do, fulfilled a sense of being a provider. You are productive; you are doing something in society that is worthwhile. So it filled that need for these men and women who mine coal, of being a provider. So when these coal miners are injured, a lot of the cases are acute pain medicine to get them back to work. They want to re-fulfill that need. So in best-case terms, that’s a short-lived thing, and then they don’t need it anymore. And with a prescription opioid, a controlled, addictive substance, sometimes that doesn’t work out that way. So that’s part of the reason, as I see it at ground zero here, how the community was kind of a target for this epidemic, this opioid epidemic.
Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “The people vs. opioid pharma: Pharma wins again.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Rebecca Thaxton: Sure. First of all, I decided to write it because the opioid crisis is a medical crisis, and I wasn’t seeing a lot of it on medical platforms. A lot of my news, like a lot of other physicians’ news, might come from medical platforms such as yours. I’m also on other email forums where I get news articles and medical news articles and read those. My morning news isn’t a regular newspaper; it’s Family Practice News or the Green Journal. That’s what I read at breakfast. So in our forums as physicians, I just wasn’t seeing a lot about it, and I wanted to hopefully share some insight about it.
And this particular one came about because my brother kind of alerted me that this happened. In the litigation, every single bit of information links to the other jurisdictions in some way, shape, or form, beyond my scope of what I could possibly keep up with. But it was breaking news for the litigation, and so I thought, if I could share some of the insight and just show what happened in California, this huge jurisdiction, where a judge ruled against the people and in favor of opioid pharma. So I hope to kind of share that insight.
Kevin Pho: So tell us a little bit about that case, and not only the judge’s decision, but the implications from that decision.
Rebecca Thaxton: OK, sure. So the decision, and I remember in the article saying I avoided certain language, because in the ruling, it talked about false and misleading promotion and marketing, and I really try to avoid the “false and misleading,” because I don’t want to put words in a judge’s mouth. The decision ruled in favor of big pharma, opioid pharma, specifically the manufacturer of the opioid medication, over the people of California, who were requesting abatement money to help with the crisis, for treatment for patients and for families to regroup.
So the judge said that it would be arbitrary of him and too difficult for him to assign a specific number, a specific monetary number, of how much marketing and promotion went towards legitimate opioid use versus how much marketing and promotion went towards illegitimate opioid use. So for that reason, he was like, “It’s a wash. I can’t do anything.”
Kevin Pho: Now, what’s your opinion on the decision?
Rebecca Thaxton: It’s hard to sue a billion-dollar company. A billion-dollar company has a lot of resources, and small people don’t have a lot of resources. So the money that the plaintiffs were seeking would have gone back into the communities, and to help with treatment, and for people who could potentially change their lives and get off of these opioids. The money could have been used for that, and instead the money will stay where it is now, which is, I guess, still with pharma.
Kevin Pho: So give us some insight about how the opioid crisis has affected the coal mining community in West Virginia. I can certainly hear implications from what you’re saying about the severity, but paint a picture of what you’re seeing at that intersection between your community and the opioid crisis.
Rebecca Thaxton: OK, sure. So when I was growing up, most people in my community, and you can imagine the small, tiny town with the little courthouse with the lawn, the little courthouse up on the hill overlooking the town. It’s extremely cute, just totally cute. And now a lot of the storefronts are empty. There’s more homelessness.
I’ll share a story as a for instance. I talked about the way the coal miners legitimately sometimes need the medications to get back to their work, to produce, and to feel like they’re providing and they’re having meaning in life and fulfilling a role. This happened another way in the coal mines too, and I hate to say this because it’s awful, but this is a true story. So there’s the guy that gets injured, and then there’s the guy that’s young, strapping, early 20s, very physically fit, able to do a lot of work in the coal mines.
And coal miners make a lot of money, particularly for overtime, and they like doing overtime because they like more money. So they get time and a half for overtime usually, and time and a half on their birthdays. So the more overtime you work, the more money you make. It’s an honor to get invited to stay on for overtime.
So a young man in his early 20s, years ago, was doing a lot of overtime, and on the third or fourth day in a row, they were like, “Hey, mister, it’s your time again. You’re going to get to do overtime again today.” And so they offered for him to stay on, and he said, “No, no, I can’t. I can’t do it. My body hurts. I’m tired. I’ve done it three days in a row now. I have to go home and I have to rest. I have to get out of this coal mine, and I have to rest.” And one of his supervisors said, “Here, try this.” And so he took the pill. It was obviously an opioid. And he explained it and said, “I felt like Superman,” and he finished that shift and finished lots more shifts, and he made $96,000 that year.
Then three or four years down the road, he had developed an opioid addiction, inevitably, and he was living in a tent in the woods with his family. He had young children, and they were heating with kerosene and cooking with kerosene. So that’s another thing that I’ve seen on the streets at ground zero here.
Kevin Pho: We’re talking to Rebecca Thaxton. She is a family physician, and she wrote the KevinMD article “The people vs. opioid pharma: Pharma wins again.” Rebecca, are there any pieces of advice and wisdom that you could pass on to other primary care physicians when they themselves have to deal with patients with opioid addiction?
Rebecca Thaxton: Well, for opioid addiction, I think it would be to seek out the resources of the community. I know in my coal mining community, there are local resources through the counties where you can go and receive counseling and help with your addiction. I think it’s being a good ear and being understanding: “It’s not your fault. It’s a medicine that takes hold of your brain, and there’s nothing you can do, and that happened to you, and I’m sorry. Let’s see where we can go from here, positively.” And I always, always think: Never give up on people. Never give up on people. So hopefully, everyone deserves another chance, and hopefully they can get it.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Rebecca Thaxton: I think a take-home message would be what I’ve learned in writing these articles and helping, trying to spread the word about the crisis: I have come to have a great deal of respect for journalistic integrity. The journalists who are breaking these news stories that I wasn’t even keeping up with, they are responsible for what they say, just like we as physicians are responsible for what we do. And so I don’t have to agree with the opinion pages of the New York Times or the Washington Post, but when I read those articles, the details that they have brought out, it’s very brave of them to write these things about some of these billion-dollar corporations. And I think that’s very important to our society, to respect journalistic integrity just as we respect medical integrity. A Facebook meme or a social media meme is not the same as an article that is put forth by a responsible journalist in a major newspaper.
Kevin Pho: Rebecca, thank you so much for sharing your time and insight, and thanks again for being on the show.
Rebecca Thaxton: Thank you. Thank you, Kevin. Have a great day.
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