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?”