A Whiteland doctor sees the impacts of the opioid epidemic in his office daily, with patients who are homeless, have lost their jobs and their kids and are suicidal.
But he also gets to be a part of them rebuilding their life, getting their family back and finding joy again.
More than a year ago — after more than 30 years working as a doctor — Dr. Simon Feng decided to quit his job as a Johnson Memorial Health family medicine physician and start his own practice, Opioid Management Group, focused on managing pain medication for patients.
“I didn’t go to medical school saying when I come out, I am going to treat heroin addicts. But I also didn’t expect it would be so rewarding,” Feng said.
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“It’s such an amazing thing to see such successes.”
Now, he has about 1,500 patients, and doesn’t have enough space or time in the day to take on anymore.
“I cannot take as many patients as I should. There are only so many hours in the day. I could work 16 hours a day and still not see all of them,” Feng said.
Feng’s practice isn’t in pain management or in addiction. He focuses on pain medication management, he said. But he also knows that pain and addiction are strongly linked, he said.
“Addiction doctors don’t understand pain. And pain doctors don’t understand addiction. They understand enough to treat the easiest patients,” he said.
His goal is making sure his patients are taking their medication safely. And that includes not suddenly taking away pain medications when they become addicted or no longer treating them when they test positive for an illegal drug or a pill they haven’t been prescribed, he said.
Feng’s interest in pain medications began about a decade ago, when he became concerned with how prescriptions were being written. Doctors were facing a lot of pressure to treat pain, with it being used to rate healthcare facilities. But at the same time, they weren’t holding patients accountable to be sure the medications were taken properly, Feng said.
He decided to do his own research and learn how to better manage pain medications. His colleagues noticed, and began referring patients to him as a family physician.
Last year, Feng decided do that work full-time and started his own practice. That meant taking a different path from most other doctors, who are joining with hospitals for additional support and resources.
“It’s a mixed blessing. We lost that financial support, but we are free to do whatever we want,” he said.
Feng is honest in his opinions about how the opioids crisis developed.
He points to America having a bigger issue with opioids than any other country, that the issue is cultural and that views have changed in the last 30 years.
Two generations ago, women in labor rarely got an epidural, and now those pain relieving medications are much more common. Thirty years ago, he would have never seen a 40-year-old construction worker taking pain pills to keep up with someone 20 years younger, he said.
The issue isn’t biology, because the pain people feel now is no different than it was 30 years ago, he said.
But culturally, pain is less acceptable now, he said.
The other big part of the problem is the marketing of pain medications by pharmaceutical companies that drummed up demand, and therefore, supply, he said.
“They were successful, and that’s not something people talk about,” Feng said.
“They are doing it to make money. In many ways, we have sold our souls.”
The growth in pain clinics, in Indiana alone, has been incredible, he said. When he first came here in 1996, he found one clinic in the state. Three years ago, he stopped counting at 80, he said.
“Nothing else in medicine has grown at that pace,” he said.
Feng also takes issue with doctors and healthcare facilities who don’t want to work with people suffering from addiction.
“They’re already in your offices. You just don’t know it,” he said.
Feng has been a critic of the mindset of pain being the fifth vital sign — a term that became popular about 20 years ago after studies and reports were published claiming pain management was being overlooked and compared it to vital signs in patients — pulse rate, temperature, respiration rate and blood pressure.
Vital signs are scientific and can be measured; pain can’t, Feng said. And even patients who rate their pain at a 10 aren’t at risk of dying like they would be if their temperature was 106 degrees or their heart rate was 200 beats per minute, he said.
But opioids do kill people, Feng said. In fact, data shows those drugs kill about three Hoosiers a day, he said.
If a doctor wanted to give a patient medication that killed three people each day for any other condition, such as diabetes or even cancer, no one would take it, he said.
“You would say, ‘Are you serious, doc? What are you trying to give me?’ But pain makes people abandon all sense,” Feng said.
Feng knows the medications he prescribes his patients are dangerous, and there are some treatments, including injections or pumps that disburse medicines, that he simply won’t do, he said.
But he also doesn’t focus on getting patients off the medications, he said.
While medical professionals should be concerned with starting patients on opiate medications, that really only is a part of the problem, he said. The bigger problem is taking those patients off those medications, which is often done too quickly, since that is when they turn to illegal drugs, he said.
“Everybody is concerned about putting people on pain pills. I’m worried about taking them off,” he said.
He relates the issue to an old saying: Riding the tiger is easy. Dismounting will kill you.
“Doctors put patients on tigers, and then knock them off. We have a responsibility to help them off the tiger, especially if we put them there,” Feng said.
Because of that mindset, Feng treats his patients differently than most other practices. If he finds out one of his patients is using illegal drugs or medications they weren’t prescribed, he doesn’t dismiss them as a patient, which many other practices do, he said. In fact, those patients make up a large part of Feng’s practice, he said.
To Feng, learning that his patient is using methamphetamine, for example, shows him he needs to work harder with them, he said.
“They just showed you they know how to get street drugs. If you fire them, they will go and get heroin,” he said.
“That means I have more work to do, not less. We don’t stop treating people, because this is a disease.”
Feng is up front with all of his patients: he doesn’t run on trust, he runs on data, including drug testing.
“It doesn’t matter who you are, I treat you all the same,” he said.
A first drug screen is required by the state and insurance companies when a patient starts with Feng. If a patient is short on pills one month or comes in looking high, Feng will order a drug test. And patients could also face a random drug screen, he said.
If someone tests positive for abusing an opioid drug, for example, that shows Feng he needs to use a different route in their treatment, he said.
That means that patient shouldn’t be getting opiate-based drugs, such as hydrocodone, morphine or Oxycontin. And he will start the process to transfer them to a different type of drug that is harder to abuse and then monitor them closely, he said. But if a patient is taking an opioid drug and having no issues with it, Feng doesn’t try to get them off of it, he said.
The discussions aren’t always easy to have with patients, but Feng and his staff said they are rarely concerned about their safety or security at work. If a patient is rude or abusive to his staff, that is one of the only reasons Feng will dismiss them as a patient, he said.
His patients also know he is trying to help them, Feng said.
The work they do is impacting generations, helping people get their kids back, make amends with their family and make lasting changes in their lives, said Barbara Mickler, nurse practitioner in Feng’s office.
“It is so very helpful for people. You do make a difference in people’s lives,” she said.
The work isn’t easy, Feng said.
They have to closely monitor every patient’s medications to make sure they aren’t taking too many or that their pills are not coming up missing — possibly being taken by someone else.
He is always on guard for the risk of an overdose and has charts and reminders all over his office and in his patient rooms.
For younger patients, the risk of overdose is highest due to drug abuse, such as with heroin. But with older patients, most often overdoses are accidental, either from mixing medications with other substances, such as alcohol or sleeping pills, from taking more because they still feel pain or from simply forgetting they had already taken their dose.
“There are so many ways it can go wrong,” Feng said.
“It’s not a job that is easy to do.”
[sc:pullout-title pullout-title=”At a glance” ][sc:pullout-text-begin]
What do you think would address the opioids crisis?
“People need to understand addiction as a disease, and not a moral failing.”
We need systemic changes, from prescribing medications inappropriately to taking patients off those medications too quickly. When you take people off the medication too quickly, you run into problems.
[sc:pullout-text-end][sc:pullout-title pullout-title=”About the series” ][sc:pullout-text-begin]
The United States is in the midst of the worst drug epidemic in history.
Opioids, including prescription painkillers, heroin and fentanyl, are killing Americans.
The Daily Journal is taking a yearlong look into the public health crisis that touches nearly every segment of our community and crosses all socioeconomic lines, from families who lost loved ones to health and law enforcement workers on the front lines.
Addicted & Dying also will explore solutions and a path forward.
Later this week, we remember a man lost to drugs and talk to a family who formed a parent support group after their daughter began struggling with addiction.
Have an idea for our project? Contact us as 317-736-2770.
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