Painkillers ease, prolong life for Moffitt cancer patients

The debate over prescription drugs continues.

By Chris Tisch, Times Staff Writer
Published March 8, 2008

TAMPA -- Tumors in Dr. James Fuller's head have made the left side of his body virtually immobile. This strains his right side, which has led to chronic back pain that makes rising from bed difficult.

Fuller, 63, was once reluctant to take prescription painkillers because of their side effects. But he began taking them regularly once he became a patient at Moffitt Cancer Center. He says the pills keep him mobile, which he thinks is prolonging his life.

"I do not want to become bed-bound and a burden on other people," said Fuller, a former surgeon who lives in Inverness.

Not all cancer patients are as willing as Fuller to take prescription painkillers.

About two out of every 10 cancer patients who get treatment at Moffitt initially refuse painkillers, said Dr. Sloan Beth Karver, the center's chief of palliative care.

A portion of those people fear they will become addicted or overdose.

Karver said she persuades most of them to change their minds, but a few resist to the end. This can cause the patient and family to suffer needlessly.

"I think a lot of these drugs that get a bad rap are very good drugs if they are used properly," Karver said. "And the types of pain we treat are very severe. And without these drugs many more patients would die suffering."

Karver is treating the sick and dying as abuse of prescription painkillers has surged in Florida.

Rehabilitation centers are reporting a wave of prescription drug addicts, while medical examiners report deaths from overdoses are rising dramatically.

A St. Petersburg Times report published in February showed that prescription drug overdoses now kill nearly 2,000 Floridians a year, about 500 of them here in the Tampa Bay area. Most of the drugs causing deaths are painkillers.

Karver and her staff worry that reports about the drugs' misuse may scare cancer patients from taking drugs they need to live comfortably.

"When our patients read reports like this it incites a lot of fear," said Charlene Whittlesey, a clinical pharmacy specialist at Moffitt. "We do have to do a counter-detail, so to speak, to get them to achieve the pain relief they desperately need."

Prior to coming to Moffitt, Fuller only took one pain pill a day, though he sometimes skipped days. Even though he felt sharp pain in his back when he walked, Fuller feared side affects like constipation. A pharmacy specialist at the center suggested upping his dose to three a day.

In addition to the pills, specialists at Moffitt have given him other kinds of pain treatment like physical therapy and even have considered acupuncture.

"We wanted an approach that wasn't just medication," said Fuller's wife, Suzanne.

Fuller was a general vascular thoracic surgeon when his first tumor was discovered in 1989. He fought the tumor off, but the paralysis on his left side prevented him from ever doing surgery again, so he went into rehabilitative medicine.

Tumors returned in 1999 and in subsequent years. Three are in his head right now. One is growing aggressively. Fuller recently underwent a month of radiosurgery treatment and physical therapy at Moffitt. He tries to exercise every day.

To stay functional -- to exercise, to undergo therapy and to even walk across a room -- Fuller says he needs prescription painkillers.

"I could not have done physical therapy without pain medication," Fuller said. "There is no way."

He swallows a long-acting morphine pill three times a day and takes a short-acting pill before exercise.

"I never thought of pain as ever being so bad that it debilitated a person until I saw it happen to him," Suzanne said. "And that's the problem. There are people out there who truly cannot walk or get out of bed because of pain who need help and are scared to death because of everything they've read and everything they've heard."

Both Fuller and Karver agree that a balance must be struck in which drugs are kept from abusers but provided to the truly hurting.

The medical field has sought that balance for years.

Fourteen years ago, the state Legislature formed a commission to study the treatment of pain in Florida. The commission found that many doctors were afraid they would be prosecuted or censured if they prescribed narcotic painkillers -- even to terminal patients.

Florida joined other states in adopting measures that protected doctors who prescribed narcotics.

As prescriptions increased, so did abuse and fatal overdoses. Family members of those who died began calling on the government to more strictly monitor the prescribing of these drugs.

Advocates for pain patients responded that too much enforcement or restriction of the drugs would leave many legitimate pain patients suffering.

As the debate continues, Karver and her staff say it's important to remember that the drugs are a necessity for patients at Moffitt.

"To me, it's unethical to expect someone to live in pain for the rest of their life," Whittlesey said. "And we have to do the best for our patients to control their pain and their functionality."

Fuller said the drug abuse problem can be better controlled if more doctors closely watch patients to whom they prescribe pills. He says the staff at Moffitt pays close attention to everything he takes.

"The most important thing, I think, is careful monitoring by the physician, careful selection by the physician," he said. "And if all of a sudden you find someone is calling in for more and more pills, you need to realign your thinking on what you want to give that patient for pain."

Town hall meeting
The St. Petersburg Times is holding a town hall meeting March 18 to allow the public to discuss prescription drug use and abuse. The forum will include a panel of doctors, treatment specialists and law enforcement. The meeting is free, open to the public and will include questions from the audience. The forum will be 7 p.m. March 18 at the Quorum Hotel Tampa, 700 N Westshore Blvd., Tampa.