Martha’s Vineyard police and physicians confront opiate abuse

A cache of pain killers seized by Oak Bluffs police in a recent arrest. — Photo courtesy of Oak Bluffs Pol

Opiate addiction on Martha’s Vineyard cuts across all ages and social classes. There is not one profile of an opiate abuser. What is certain is that the abuse of prescription painkillers is a growing problem, one with a ripple effect throughout the community, police and doctors on the front lines say.

Last week, members of the Martha’s Vineyard Drug Task Force (MVDTF) stopped a tow truck driver who said he sold percocet pills to support his heroin habit. In a second case, police arrested a known opiate dealer who had just filled a legitimate prescription for 180 oxycontin pills.

While the details varied, in each instance opiates played the central role. Increasingly, the weekly Martha’s Vineyard court report documents a growing problem on the Island, matched statewide, a problem that is attracting the attention of lawmakers.

Last week, the Massachusetts Senate formed a special committee to address what Senate President Therese Murray called the “epidemic” of opiate addiction in Massachusetts.

“Since 1999 the state has seen a 47 percent increase in overdose deaths from prescription painkillers,” said Ms. Murray in a press release. “I’ve sat in the drug courts in my own district and it just tears your heart out to see families coming and pleading with judges to put their children away—adult children, not just small children.”

The pills that were created to rid people of pain are creating more and more of it.

As part on an ongoing series about opiate addiction here, The Times spoke with Island physicians and law enforcement to gauge the extent of the epidemic here, and to see what can be done to fight it.

Pills become a societal ill

The United States makes up 4.6 percent of the world’s population, but consumes 80 percent of all manufactured opioids, according to IMS Health, the largest vendor of U.S. physician prescribing data. Between 1991 and 2010, prescriptions for opiates increased from about 75.5 million to 209.5 million, according to the National Institute of Drug Abuse (NIDA).

According to the Centers for Disease Control and Prevention (CDC), opiate overdose deaths in the United States have more than tripled since 1990, and now cause more overdose deaths than cocaine and heroin combined. The fastest growing group of addicts is 12-17 year olds—nearly one in 12 high school seniors reported non-medical use of Vicodin; 1 in 20 reported similar abuse of oxycontin.

“It’s a much bigger problem than most people realize,” said Dr. Pieter Pil, chief of the medical staff at Martha’s Vineyard Hospital, in a telephone conversation with The Times. “Fifteen, twenty years ago, the patient is in pain, we gave him or her narcotics. Now we know that’s not a good idea. The body quickly becomes tolerant of narcotics and requires escalating doses. Then you’re putting into circulation doses of medication that may be appropriate for one person, but way too much for another.”

Dr. Pil said physicians at Martha’s Vineyard hospital require a signed pain contract with their patients before prescribing any painkillers. “It says, ‘I understand you have pain, here’s how we’re going to control it. If you get 20 pills for ten days, that’s all you’re going to get, whether you lose the pills or your dog ate them, that’s it, period.'”

The CDC estimates that emergency department visits for prescription painkiller abuse or misuse have doubled in the past five years to nearly half a million. Dr. Pil said in an emergency room situation, it’s particularly difficult to determine if someone is pill shopping.

“The emergency room is very different because the emergency room physician doesn’t have a relationship with the patient and doesn’t know if the patient truly has pain or whether the patient is getting the medication to divert. That can be very hard to sort out. If you go in and say you have back pain, there’s no medical test to see how bad the pain is or if it even exists.”

Dr. Pil said ER physicians are aware of the abuse issues, so they tend to prescribe lower quantities to get through the immediate crisis.

While to many, a prescription for 180 pills might seem excessive, medical conditions differ from patient to patient.

“Would I look at a prescription of 180 pills more than 40 pills? Yes,” said Dr. Pil. “But a patient with chronic severe pain is a patient who’s probably markedly tolerant. What may seem like an outrageous amount for one patient, enough to knock down an elephant, can be a minimal amount of medication for patients with a built up tolerance.”

Rise in crime

Edgartown detective sergeant Chris Dolby said there has been rise in crime on the Island linked to the rise in opiate addiction. “In 2011, we had 60 homes broken into in Edgartown, all directly connected to individuals trying to feed their addiction to pills,” he said. “We had a series of about 20 break-ins in 2012, also tied to an addict. Last year around 30 break-ins were tied to addicted individuals.”

Sergeant Dolby said that there was also a known addict whose court appearances coincided with car break-ins in downtown Edgartown. “He was taking cash and credit cards to feed his addiction,” he said.

According to Sergeant Dolby, prescription drug abuse cases are some of the most challenging investigations for law enforcement. “They’re not a normal drug investigation because at any given time the person can legally possess those pills. If I go into someone’s house and find pills with their name on it, that’s not illegal. We literally have to catch them red handed, which is very difficult to do.”

Sergeant Dolby said that the increase in opiate addiction has also led to a spike in heroin addiction on the Island. “As is often the case, when people can’t get pills, they resort to heroin. A lot of these people would never in their lives dream that they’d be a heroin addict, but it’s only substance that fills the craving. Heroin died out for a while until the pills became popular, all of a sudden heroin was right back on the scene.”

Last week, Mr. Dolby and members of the Drug Task Force arrested Bryan A. Cimeno, 45, of Morgan Way in Edgartown on a charge of possession with intent to distribute oxycodone. He was also charged with conspiracy to violate drug laws.

According to the police report, Mr. Cimeno had 64 oxycodone pills in his vehicle at the time of his arrest, and during booking at the Dukes County Jail, police discovered 10 more oxycodone pills concealed in the brim of his hat.

“He has a legitimate prescription for 180 oxycodone pills every 15 days,” Det. Sgt. Chris Dolby said in court, acting as prosecutor for the Commonwealth. “These pills are being diverted and sold.”

Police also summoned Mr. Cimeno’s wife, Carrie A. Cimeno, 39, of Morgan Way, Edgartown as a co-defendant in the case.

Also arrested was Brianna E. Combra, 23, of Edgartown-West Tisbury Road in West Tisbury for possession with intent to distribute oxycodone, and conspiracy. Police seized 37 oxycodone pills and $779 in cash from her when she was arrested.

Sergeant Dolby said Mr. Cimeno was selling pills to Ms. Combra for $15 apiece and she resold the pills for $25 apiece.

Broken contract

Dr. Gerald Yukevich is on the staff of Vineyard Medical Services, a private clinic on State Road in Vineyard Haven that provides primary and walk-in care. A former hospital emergency room doctor, he is widely known and respected in the community.

In a telephone conversation with The Times on Monday, Dr. Yukevich said

he also enters into pain contracts with his patients. Asked to comment on the arrest of his patient, Mr. Cimeno, Dr. Yukevich said, “I’m very sorry this event happened,” adding that he could not comment on particulars of the case because of patient confidentiality laws in the Health Insurance Portability and Accountability Act (HIPAA). “Pill diversion is a problem because there’s no real way to know if someone is going to lie to you, and you can’t prevent them from doing something that’s dishonest.”

Dr. Yukevich said that in a general sense, the amount of pills prescribed for Mr. Cimeno—180— is not necessarily unusual.

Fighting back

In 1992, the Massachusetts Department of Public Health (DPH) established the Prescription Monitoring Program (PMP) to track controlled substance prescriptions written by doctors in the state. Both doctors and law enforcement say the PMP has been extremely helpful in battling opiate abuse.

“Before the PMP, you had no idea what this patient was taking,” said Dr. Pil. “If you suspect the patient is pill shopping and you check the PMP, it becomes apparent very quickly. That said, there is a wide range of acceptability in pain management.”

“The PMP has helped law enforcement considerably,” said sergeant Dolby, who noted that access to the PMP by law enforcement is restricted. “I need to have a legitimate open investigation to put anyone’s name in there. I don’t have an investigation open on any doctors on the Island right now, so I don’t have the right to search it.”

Paradigm shift

Dr. Pil said the addiction epidemic has spurred major changes in pain management protocol at Martha’s Vineyard hospital, and elsewhere.

“The paradigm is shifting from pain medication to managing the pain with other means. It’s not about eliminating all pain, but managing pain to the point where people can have a productive life,” he said. “Steroid injections into the spine, and radiofrequency ablation—a probe generates heat from high frequency current and destroys the nerve that carries the pain signal to the brain—are highly effective pain reduction techniques.”

Martha’s Vineyard hospital, in conjunction with Massachusetts General Hospital, has established a pain clinic and intervention service. Cheryl Kram R.N., a high risk intervention and pain nurse, hosts video conferences with patients and Mass General doctor Chris Gilligan, to evaluate how pain can be controlled without narcotics. “The demand has really taken off,” said Dr. Pil. “It’s been unbelievable.”