HORRY COUNTY, SC (WMBF) - Over a three-year span, seven doctors in the Grand Strand and the Pee Dee wrote nearly 71,000 prescriptions for fewer than 13,000 elderly or disabled patients enrolled in the Medicare prescription program.
They are among the top 1,000 highest prescribers in the Medicare Part D program, which provides drug benefits to the elderly and disabled, who collectively wrote 14.6 million prescriptions between 2013 and 2015, public records show.
Many of the area doctors specialized in pain management, in some respect. As of February 2018, all of their licenses with the South Carolina Board of Medical Examiners were in good standing.
WMBF News reached out to the doctors to get their take on those numbers. Three of them responded, and they have very different perspectives on where the country is today in the opioid epidemic and what role physicians play in it.
Dr. Scott Sauer is No. 579 on the list. His website states he has provided pain management services to the Myrtle Beach area since 1999.
In his opinion, it isn't an opiate crisis, but instead, an addiction issue.
In a written statement, Sauer said:
A WMBF News investigation found prescription opioids do play a huge role in the overall epidemic.
According to the state Department of Health and Environmental control, a majority of overdose deaths involving opioids in South Carolina have been caused by prescription opioids.
The numbers don't paint the whole picture, and they don't say where the user got the drugs. However, in 2015, 512 of the 566 opioid overdose deaths in South Carolina involved prescription opioids. Only 95 involved heroin.
Those numbers went up in 2016. Approximately 550 of the 616 total opioid overdose deaths were prescription-based and 108 were from heroin.
For some experts who are working on this problem at the state level, it's clear that doctors have played a role in where the area is today with this epidemic.
"There's a lot of evidence that people that are now doing heroin and other drugs started with prescription opioid medications," said Christie Frick, the director of the prescription monitoring program for the S.C. Department of Health and Environmental Control. "We think it's taken a while for us to get to this point. There's a lot of things that have happened over the past 20 years I think have contributed to the problem. Practitioners and pharmacists were taught that pain was under-treated back in the 90s, pain was the fifth vital sign. So, there were a lot of things that pushed prescribers to write or put a lot of patients on opioids without all of the precautions of addiction and worried about those kinds of situations."
Dr. Jeffrey Wilkins echoed some of those same sentiments. He was the second-highest Medicare prescribing doctor of opioids locally between 2013 and 2015.
He wrote about 7,403 prescriptions for 1,518 patients during that time frame. Since then, he's gotten out of this type of pain management.
"Patients with addiction and patients who are diverting have a very high motivation to fool you," Wilkins said. "It can be a challenge to walk that line between being compassionate and helping a fellow man in pain and not getting fooled."
Wilkins said he doesn't miss that kind of medical responsibility.
"You spend a lot of time in that exam room looking at that person, not as someone coming to you saying they have high blood pressure, I have high cholesterol," Wilkins said. "You're wondering, 'Are they trying to pull something on me?' At the same time, your primary role as their doctor is to help them with their misery and that double bind is just very difficult."
Through urine samples and pill counts, even criminal background checks, Wilkins said he vetted patients the best he could to make sure the pills he was prescribing were going to a patient who needed them.
The liability, government restrictions and high level of scrutiny are all reasons Wilkins said he and others have moved away from opiate prescriptions and why he believes doctors like the ones on the list WMBF News obtained seem to be prescribing high amounts of the drugs.
"Even our pain management guys don't want to do it," Wilkins said. "You're getting a smaller and smaller number of people that feel comfortable enough to write opiates, where if you print out a list of top providers, well you're sort of the last guy standing.
Wilkins said not all patients know how they may be affected by the drugs their doctors prescribe.
"You're generally not going to be addicted without exposure," Wilkins said. "You take an addictive personality, addictive genes and exposure, and you are asking for trouble, and the only way to completely avoid that is to not prescribe to anybody, which is not humane."
Another doctor on that list of top 1,000 prescribers is Dr. Walter Evans, who ranked at No. 981.
In a letter to WMBF News, Evans said his practice terminated its controlled substance program in March 2017 due to the excessive administrative and financial burden of monitoring controlled substances being required by the Drug Enforcement Agency and DHEC.
He added the change was not due to restrictions or limitations placed on his license.
"I have witnessed the devastation in my patients' lives caused by the restrictive and heavy-handed policies of the DEA," Evans said. "Instead of giving these patients narcotic prescriptions, which allowed them to lead active lives, I am prescribing wheelchairs and other assistive devices to help them stay out of a nursing home. I grieve for those victims of the current opioid epidemic. But I also grieve for my patients whose quality of life has been sacrificed by the DEA because of their inability to control illegal drugs."
The doctors' complete statements can be read below:
It's hard to ignore how the opioid epidemic in South Carolina has impacted almost every level of the community, from families and neighborhoods to the economy and jails.
For many addicts, they say their spiral into addiction started with a visit to a doctor's office.
One woman, who didn't want to reveal her face or her name, shared her story.
The scars on her arms and hands remind her of how far she's come.
"I kind of killed that vein," the former addict reminisced. "We never knew something a doctor prescribed you could be a 'drug,' nor your body could become dependent on it."
The woman said her dependence on the drugs was fueled by an abusive relationship with a former boyfriend and a lack of education about how addictive opioids could be.
"You're a kid. You have a surgery. You get prescribed a controlled substance," the woman said. "It ruins your life."
Through tears, the woman shared how she believed she had wasted a decade of her life.
"You were prescribed and then it lead to one thing, lead to the next," the woman said.
That next thing for her was buying stronger pain killers off the streets, then heroin and fentanyl.
"It turns you into a completely different person," the woman said. "It's really hard to look back at and think about the stuff you did. "
The craving for opioids was so strong, the woman said she used until the eighth month of her pregnancy with her daughter.
"I didn't want to give up the drugs," she said. "To me, what I had planned … that's how I was going to die. I was going to die at an early age. I saw myself as a loser. I thought I had already ruined my life. There is no changing it. I thought that everyone now views me as just some addict trash, nothing. It all changed the day I had her."
The woman said she has been clean for three years, but the journey has not been easy.
She said she struggles every day to beat her addiction and it's hard to not get back in the cycle because she can't get a job due to her criminal record, and she can't pay for a college education because she isn't employed.
Below is a map showing the number of overdose deaths linked to prescription opioids across counties in the Grand Strand and the Pee Dee. For a full-screen view of this map, click here.