Reversing the trend: Nelson County’s top opioid prescriber has actively changed course

Lois Alderfer, who has been a family nurse practitioner in Virginia for 28 years, is the medical director at BRMC. (Photo: Zachary Wajsgras) Lois Alderfer, who has been a family nurse practitioner in Virginia for 28 years, is the medical director at BRMC. (Photo: Zachary Wajsgras)

The bombshell dropped on July 16.

A report in The Washington Post, based on newly available data from the Drug Enforcement Agency, revealed every manufacturer, distributor, and pharmacy involved in the opioid crisis, and tracked the role each one played in the process that placed highly addictive prescription painkillers in the hands of patients.

In Arrington, employees at the Blue Ridge Medical Center were taken aback to see that their employer was the leading recipient of opioid painkillers in Nelson County by a wide margin. From 2006 to 2012 (the period covered by the database), BRMC received more than 1.1 million opioid pills, enough to prescribe each of the 2,263 people who live within 10 miles of the facility 74 pills a year, according to the Post.

“The results came out and the Blue Ridge Medical Center prescribed more opiates than [nearly] the rest of the pharmacies put together in Nelson County,” says Dr. Andrew Hodson, a board member at BRMC. “So if you wanted to point a finger at someone, it was the Blue Ridge Medical Center.”

Starting in the 1990s, an increase in the prescription of opioid painkillers led to an escalating addiction crisis that continues to this day. Nationwide, more than 130 people die every day from opioid overdose (including heroin and fentanyl, as well as prescription painkillers).

Hodson acknowledges that the high volume of opioid prescriptions continued well past the range of the DEA database; BRMC reports that it dispensed over 300,000 opioid painkillers per year from 2012 to 2016—a period during which the Virginia Department of Health says three people died in Nelson County due to opioid overdose.

After a few of the “old-school” physicians who, according to Hodson, prescribed “virtually anything anyone asked them to prescribe” retired in 2017, the medical specialists at BRMC realized they were enabling a culture of dependency among their patients.

“When we had providers leave, we decided we had to address this,” says Lois Alderfer, a nurse practitioner and the medical director at BRMC. She doesn’t blame the doctors who left, but says the facility “looked at what was recommended, came up with a policy and procedure, and that’s what we’ve been following—and our numbers have gone down significantly.”

After never falling below the 300,000-pill threshold, BRMC cut that figure in half in two years, reporting just over 120,000 prescribed painkillers in 2018. Stricter restrictions were put in place that limited physicians from signing off on more than 30 morphine equivalents for a patient—roughly equal to 200 mg of codeine—unless recommended by a pain specialist.

If patients are prescribed painkillers, Alderfer says they must make regular check-in visits to BRMC, sign an “annual pain contract,” and submit to a drug screening. Nurse practitioners have been tasked with encouraging alternative forms of pain management like acupuncture, massage therapy, chiropractic work, yoga, swimming, and strength training.

Thanks to a federal grant BRMC received in May, the facility has also been able to cover up to $1,000 in expenses for qualified patients to participate in these alternative services. In most cases, that means patients don’t need to get their insurance companies involved.

“We use the global pain scale to try to judge what was their pain at the beginning and how did it change over the course of the time,” says Mary Schimm, a BRMC counselor who works with the program. “We have found that the pain scales demonstrate people are reducing their pain during the therapies…and then we try to help them develop a plan for how they’re going to maintain staying in more of a pain-free state.”

Nelson is far from the worst county in Virginia when it comes to enabling opioid addictions—the DEA database points to the southwest region of the commonwealth as the most heavily impacted area, and Nelson trailed Charlottesville in opioid prescriptions during that time frame.

But as the leading prescriber of painkillers in its community, BRMC hopes to send a message to other pharmacies around the country that the medical community needs to take responsibility for its role in the opioid crisis and address new approaches to pain management head on. BRMC is still working on determining its next step after the grant runs out (Schimm believes they’re on track to do so in December), but it aims to continue promoting these alternative approaches to pain management over opioid prescriptions.

“It’s very simple: You’re taking care of people,” Hodson says. “Medicine today doesn’t take care of people. You get a billing code, you pay your money, but you’re not actually being cared for.” He wants patients to ask themselves, “Does your medical care give you medical care?”

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Jeff
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Jeff

How many people are being tortured to death from lack of access to opioid analgesics? How many suicides now caused by lack of pain control? What is the overdose rate? what is the correlation between prescription rates and overdose fatalities?

Kelley Thornton
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Kelley Thornton

This article and these Drs are insane, I’m ashamed to read that they fell into the hands of PROPAGANDA, failing to account for the fact that they are in a community that people travel from all over to visit. And are tending to a large number of elderly populations, and to read they ” ousted ” out the old timers is even sadder, getting rid of the Drs with knowledge, and now relying on ” Drs” who treat patients by telling them their pain is a weakness and mental disorder, rather then a physical ailment, how they can justify the… Read more »

Michelle
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Michelle

And thanks to ANOTHER biased “opioid hysteria” article, myself and millions of others will have to work that much harder to get proper treatment for our painful conditions & diseases. That includes our VETERANS, CHRONIC PAIN PATIENTS, ELDERLY & DISABLED PEOPLE! Our VETERANS are commiting suicide at an alarming rate bc they’re being included in with addiction. ALL of our groups suicide rates are going up. I am sorry for the loss of Life due to illegally obtained medication & illicit fentanyl/heroin but I am tired of having to fight for the right to treat my pain. What until its… Read more »

Shay
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Shay

This is the most difficult time it has ever been to be a Chronic pain patient, Veteran, Elderly or a Disabled person. theres an attitude towards us of scorn & discrimination by people in medicine, the media & by people in general. it has gotten so negative, intolerable, unempathetic. WHERE has the compassion gone? its so tragic what has become of the chronic pain community, it’s horrific and it needs to stop. it is impossible to make those who aren’t experiencing chronic pain understand how bad it is out here for us & its nothing less than a massive human… Read more »

K. Walters
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K. Walters

Do the math please. If 1,000 patients (a low number for a practicing clinician)each took 4 pills a day, that= 4,000 pills a day. Multiply that by 365 = 1 MILLION, 460 THOUSAND PILLS. The math this author uses does not include a denominator. This display is designed to sensationalize. Don’t be fooled!

Paula
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Paula

You are going too far with all this opioid nonsense..they give people in pain a reason to live..massage acupuncture and all that other stuff is never going to be covered under insurance and opioids being denied to people who are having surgery or cancer is a joke.why do you want people to suffer more if you think people are suffering because they have addiction problems why are you now going to make everyone in pain suffer? Everyone has gone completely nuts with this street drug crisis it didn’t all come from prescription painkillers. these pain killers have been around forever… Read more »

Holly Agouridis
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Holly Agouridis

this Is horrific . How can you deny anyone pain meds? If you only knew what the patients go through on a daily basis. We don’t use these meds to get high. We don’t abuse or misuse them. We are not drug seekers. The majority of us have tried chiropractic sessions, message, yoga, injections, meditation and I swim 4 times a week for an hour and it DOES NOT work to relieve my pain at all. So basically chronic pain patients are being victimized and profiled because of drug addicts. If you break down the numbers per patient the average… Read more »

Lisa
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Lisa

Propaganda. What happens after that 1000$ is used up in a months time on alternative therapies? That aren’t covered by insurance. What they are doing is thinning the heard by cutting off access to legal medications to ppl in dire need. Even cancer patients are bring denied pain medication for fear they will become addicts. It’s an epidemic of lack of common sense & compassion for the suffering. This nurse practitioner drank the koolaid. Medical providers are simply doing what’s “safe” for them and if there patients goes home & commits suicide bc they cannot live another day in pain,… Read more »

Lala
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Lala

It is time to listen to the voice of people suffering in debilitating pain before we take our lives because the pain is unbearable. We are trying to live our lives and be productive members of society which is more difficult when you are in constant agony. What is the difference between a drug addict overdosing…or chronic pain patients ending their lives because the suffering is so horrific without medication to ease some of the pain? Do our lives and voices do not matter? The government did not go to medical school and should not be telling doctors how to… Read more »