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On Sept. 30, 2016, Melanie Weiss, O.D., was in handcuffs in the back of a patrol car. Just 15 minutes earlier, she was seeing patients at Weiss Eyecare Clinic, her private practice in Watertown, SD.
“I remember looking at their badges, but I still didn’t think I was going to be arrested. Drugs just do not let your mind go to the consequences,” recalls Dr. Weiss, who is recovering from opioid addiction. “I honestly thought the detectives were going to say, ‘Melanie, you should probably get back to work.’ Obviously, that did not happen.”
Here, along with related facts regarding opioid abuse, Dr. Weiss discusses her journey from abuse to recovery in the hopes of helping others who are grappling with opioid addiction, be it themselves or someone they know.
SURGERIES
Within roughly five years of the 2003 cold opening of her practice, Dr. Weiss underwent an appendectomy, hernia repair and knee surgery, for which her physicians prescribed opioids for post-op pain.
“I took the medications as prescribed for my appendix and hernia surgeries. By the third surgery, however, I started using more than what was prescribed, attesting the additional use to having built up a tolerance,” she explains. “I had taken pharmacology classes, so I knew what opioids do to the brain, but I also thought, ‘I’m smart; I know when to stop.’”
Prescribed two pills every four to six hours, Dr. Weiss divulges she raised it to two and a half, then three, three and a half and on.
“For most people, opioids make them feel sleepy. For me, it was the opposite. I felt like I could go from 6 a.m. until 2 a.m. and be the best eye doctor, the best boss, the best mom — I have three daughters — and the best wife,” she asserts. “Both physically and mentally, the opioids made me feel like I was superwoman.”
FACT: Opioids attach to and activate natural opioid receptors located on nerve cells in the brain, among other organs. They work to block pain signals, while delivering surges of dopamine to the brain’s reward circuit, creating feelings of euphoria. Long-term opioid users can build up a tolerance, prompting them to increase their dosages and frequency of use. Additionally, opioid use causes confusion, constipation, drowsiness, nausea and slowed breathing, according to the National Institute on Drug Abuse (NIDA, www.drugabuse.gov ).
ADDICTION
Convinced she was an “amazing” optometrist when using the pills and, thus, that she couldn’t function without them, Dr. Weiss acknowledges she began taking pills from her family members’ cabinets — she says they never noticed — after exhausting refills from her orthopedic surgeon to satiate her craving. When the family supply ran out, she says she turned to writing prescriptions for family members to fill for her personal use.
“To prevent suspicion, I never asked a family member to fill a prescription twice, and I always made up a reason, like I slipped on the ice and hurt my back and didn’t have time to see a doctor,” she points out.
Dr. Weiss says her brother-in-law abruptly cut off her pill pipeline in 2011 when he reported her to the Watertown Police for writing an opioid prescription for her nephew. The result was police questioning, the Drug Enforcement Agency (DEA) confiscating her license and her state board requiring her to undergo 12 months of random urine drug screenings, as part of a 12-month state board license probation.
“At that time, I thought, ‘this is actually a good thing.’ I know I need to quit; I’m not happy with the person I’ve become, and this will make me accountable,” she describes. “But I ended up manipulating the screenings by lying about being out of town when asked to show up and then coming in when I knew the opioids would be out of my system. I just could. Not. Quit.” (See “Create a Practice Policy to Address Abuse,” left.)
FACT: Drug addiction is a chronic disease comprised of uncontrollable drug-seeking and use, regardless of consequences, reports NIDA. This behavior occurs from drug-induced brain changes that challenge the user’s self-control.
Practice Preparations
DR. WEISS SAYS SHE WAS ABLE TO FOCUS SOLELY ON HER RECOVERY, THANKS, IN PART, TO:
→ Disability insurance. “My disability insurance completely 100% saved my practice,” she asserts. “I had overhead disability, and I had two personal disability policies that, thank goodness, covered addiction.”
→ Delegation. A couple years before her arrest, Dr. Weiss says she no longer “micromanaged” her staff, so they were able to keep operations going in her stead. She adds her husband oversaw the practice’s business side.
→ Optometrists. Drs. Kevin Brown and Clarence Vanderlei, among other O.D.s, took the reigns. “Drs. Brown and Vanderlei practiced roughly three hours from my clinic at the time, caught the local news about my arrest, called my staff and told them they were available to help, if needed,” Dr. Weiss, explains, choked up. “I’d met Dr. Brown at an O.D. meeting. They saw my patients for two months, twice a week.”
The practice then found two temporary optometrists to fill in for the duration of her incarceration, with one who committed to a full year.
Create a Practice Policy to Address Abuse
PRACTICES SHOULD CONSIDER CREATING A DRUG-FREE WORKPLACE POLICY THAT INCLUDES PRESCRIPTION MEDICATIONS, RECOMMENDS THE NATIONAL SAFETY COUNCIL (NSC). BELOW ARE EXAMPLES OF WHAT THIS POLICY SHOULD BE COMPRISED OF, AS SUGGESTED BY THE NSC REPORT “THE PROACTIVE ROLE EMPLOYERS CAN TAKE: OPIOIDS IN THE WORKPLACE.” NOTE: PRACTICES SHOULD CONSULT A LAWYER TO ENSURE THE POLICY MEETS STATE AND FEDERAL GUIDELINES. (See https://bit.ly/2JQUZXb .)
→ Clear documentation. Explain, for example, the employee’s responsibilities for understanding how a medication they take may affect job performance. Additionally, the policy should state the specific circumstances that will lead to disciplinary action. Further, if the practice employs drug testing, the policy should include the testing procedures. Finally, employees should sign a written version of the policy, acknowledging they have read it.
→ Managerial training. Include a review of: the practice’s drug-free workplace policies; the laws regarding prescription drug use while at work; signs of impairment, such as poor decision-making; when there is reasonable cause to use a drug test; and any specific drug screening the practice employs.
→ Drug testing. Drug testing can identify drug abuse and also reduce abuse by virtue of creating the fear of consequences, such as a job loss. (See https://bit.ly/33qeyyN .)
→ Access to an employee assistance program (EAP). Consider providing confidential access to an EAP (https://bit.ly/2KAkwV6 ), which connects employees to treatment programs. EAPs have been shown to provide positive returns on investment.
For the full NSC report, visit https://bit.ly/31uyZZy .
TREATMENT
When not using to pass the screenings, Dr. Weiss relays she experienced unrelenting cravings, vomiting, diarrhea, excruciating body aches, insomnia, hyperactivity and, at times, a nebulous mental state, all of which convinced her to seek and enter an accelerated treatment program.
“I enlisted in a two-week program in California, covering with a story that I needed to help an ill optometrist,” she confesses. “I thought being gone from work longer than that would hurt my practice and raise suspicion in my family and staff, who had no idea I was struggling with addiction.”
FACT: Opioid withdrawal symptoms include all of the above, along with cold flashes with goose bumps and uncontrollable leg movements, reports NIDA. Additionally, research reveals most drug addicts require, at minimum, three months in treatment to get a grip on their disease, with the best results occurring with prolonged treatment, according to NIDA.
RELAPSE
Within a couple months of returning from treatment, Dr. Weiss says she began doctor shopping, or seeing several local doctors at once, to obtain opioid prescriptions to feed her addiction.
Fearing the state’s newly created prescription-monitoring program would flag her and, in turn, revoke her optometry license, Dr. Weiss says she replaced doctor shopping with burglary.
“I started using my own daughters as bait,” she concedes, through tears. “When they were at friends’ houses, I would find a reason to drop by. Once inside, I’d ask to use the bathroom and then take every pain pill available.”
This practice escalated into raiding the medicine cabinets of friends she knew weren’t home, Dr. Weiss says.
FACT: Relapse rates for opioid addicts can be as high as 91%, reveals the International Journal of Psychiatry in Medicine. Additionally, health care providers addicted to opioids are at an even higher risk of relapsing vs. the general public, shows JAMA. Further, brain imaging studies of addicts reveal brain changes in areas responsible for behavior control, decision-making, judgement, learning and memory, according to NIDA. (See “Prescribing/Patient Resources,” left.)
Prescribing/Patient Resources
→ CDC: Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: https://bit.ly/2yrWNkK
→ AOA: Opioid Crisis-a U.S. Public Health Emergency: Recommendations for Doctors: https://bit.ly/2AxKkxZ
→ Substance Abuse and Mental Health Services Administration: Behavioral Health Treatment Services Locator: https://bit.ly/2jQLyvJ
→ American Society of Addiction Medicine: Opioid Addiction Treatment: A Guide for Patients, Families and Friends: https://bit.ly/2GLXlao
→ U.S. Department of Health and Human Services: How to Find Opioid Treatment Programs?: https://bit.ly/2GTt8WL
Prescription Pain Reliever Misuse
COVERT MISSION
One day, in noting she had a 15-minute window until her next patient, Dr. Weiss says she entered the empty home of a fellow church congregation member, took the member’s pills and exited, facing Watertown detectives. At that point, she acknowledges she was taking 15 pills at one time, three to four times a day. It was Sept. 30, 2016 and the end of eight years of abusing opioids.
“When my husband found out what I’d been arrested for, I could see in his eyes that all the pieces were coming together for him,” Dr. Weiss remembers. “He said he thought I was having an affair because I had been so secretive, hardly home and when I was home, very short, angry and distant with him.”
Daughters, Becca, Allie and Abby, teenagers at the time, were completely shell shocked, she adds.
Dr. Weiss plead guilty to second degree burglary and two counts of Entering or Remaining in a Building. A South Dakota Codington County judge sentenced her to 180 days in jail, with 70 days served for time spent at the Hazelden Betty Ford Foundation’s Health Care Professionals program, in Center City, Minn. During her treatment, she says her parents divulged a family history of addiction. (See “Practice Preparations,” p.40.)
FACT: The behavioral signs of drug addiction include increased aggression or irritability and attitude/personality changes, among others, reports American Addiction Centers. Also, while opioid addiction does not have a clear inheritance pattern, several addicts do have a family history of addiction to substances, reports the National Institutes of Health.
Help for Professionals
PRESCRIPTION DRUG ABUSE AND ADDICTION RATES ARE FIVE TIMES HIGHER IN PHYSICIANS WHEN COMPARED TO THE GENERAL PUBLIC, WITH PARTICULARLY HIGH RATES OF OPIOID AND BENZODIAZEPINE ABUSE, REPORTS THE HARVARD REVIEW OF PSYCHIATRY.
“When I was going through it, I, honestly, in my mind thought I was the only health care professional that had an issue,” Dr. Weiss says. “But I enlisted in the health care provider program at Betty Ford, and I met so many other health care providers who struggled with addiction.”
Resources for those who may have a problem include:
→ American Addiction Centers: Drug Addiction Quiz: Do I Have a Drug Addiction?: https://bit.ly/2ZDRREV
→ Drug Addiction in Health Care Professionals: https://bit.ly/2yJyCjN
→ Federation of State Physician Health Programs: https://bit.ly/2SdnOzm
IN RECOVERY
Dr. Weiss returned to practice Jan. 2 with the backing of her family, friends, employees, fellow Watertown residents and South Dakota’s Health Professional’s Assistance Program (HPAP), which provides support for healthcare providers who have substance abuse issues. HPAP is monitoring Dr. Weiss with random, “impossible-to-manipulate” drug screenings for five years, at the behest of her state board, she says. Then, she can reapply for her DEA license. (See “Help for Professionals,” left.)
“The one thing that I wish I would’ve done differently is let somebody know I had a problem. I didn’t because I was scared my family, my employees and my patients would leave me,” she confesses. “But that didn’t happen. Everyone has been so supportive.”
Once a week, Dr. Weiss operates Vision of Hope (myvisionmyhope.com ), an organization she founded to personally educate about opioid abuse.
“I’ve learned so much from this experience: I’ve learned that addiction runs in my family; I’ve learned how amazing and forgiving people are; I’ve learned I’m not the only health care professional in recovery; I’ve learned I am a better and happier person and doctor without opioids; and I’ve slowly learned how to forgive myself,” Dr. Weiss explains. “I want anyone who might be struggling with opioid addiction to know all that!” OM
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