01/28/2020
Off the hook
PIH Health doctor a national expert in substance abuse therapy
By Tim Traeger
Editor
The Friendly Hiller
When Corinna Megan Ortega was found dead at Parnell Park on New Year’s Day, it dumped the nation’s exploding opioid epidemic squarely at our doorstep. The 22-year-old was found unresponsive in a tent surrounded by transients she had reportedly been partying with the night before.
The tragedy is not new to Dr. Randolph P. Holmes. The spry 69-year-old is one of the preeminent authorities on substance abuse and addiction in the United States who is also a family medicine doctor in Whittier. Holmes has spent decades treating “many thousands” of patients in his family practice, but the battle against opioid addiction is where his true passions lie.
“Many, many thousands of lives are being lost to overdose deaths – from op**tes, alcohol and tobacco,” Holmes said in the living room of his Friendly Hills home. “I think the drug companies play a part, but I don’t blame them entirely. I think part of the mess we’re in now is due to an over-emphasis on pain. I think hospitals and national accreditation agencies nationwide emphasize pain relief. In the 1990s they had a campaign that said pain was a fifth vital sign … doctors were being graded on how well they controlled pain, so there was a big push to treat pain, primarily with more op**tes.”
Holmes chairs the Public Policy Committee for the California Society of Addiction Medicine. He laid out how nationwide dependence started with the prevalence of OxyContin, morphed into a reliance on he**in and now faces lethal fentanyl.
“Doctors started being graded and criticized or penalized if patients said they weren’t treating their pain adequately. We responded by saying, ‘fine. We’ll just prescribe more op**tes.’ The pharmaceutical companies responded by producing newer versions of op**tes to answer the demand. We were prescribing more. Patients were demanding more pain relief,” said Holmes, who travels each year to Sacramento and Washington, D.C. to write policy on the issue.
“There was a whole constellation of things that came together in the late ‘80s and early ‘90s. The companies released a drug called OxyContin and began promoting the drug. In parts of the country where there were large numbers of people on chronic pain medication – primarily in the industrial rustbelt areas of West Virginia, Ohio, Virginia, a lot of coal miners and the logging industry.
“There were a lot of injuries and doctors were overzealous. By the end of the ‘90s we were in a full-blown pain-pill epidemic,” Holmes said. “Entrepreneurs got into the game and in the 2000s there were pill mills - doctors opening up pain clinics and prescribing thousands and thousands of doses of pain pills. By about 2008 and 2009, we began to shut down the pain pill clinics in Florida and California.
“Laws were enacted to shut these pain-pill mills down. By then we had hundreds of thousands of people that were inappropriately prescribed large amounts of predominately op**te pain pills. Narcotics. And they were dependent,” Holmes said. “They couldn’t stop. So what happened is we had a huge influx of he**in. The Mexican mafia saw a very good business opportunity. They had a huge number of people who were now dependent on op**tes. The doctors are not prescribing them anymore. So they moved in with vast quantities of he**in. About 2009, 2010, you began seeing a huge influx of he**in- primarily black tar he**in in the Western United States. He**in from Afghanistan.
“By 2011 most of the people dying from overdoses were dying from he**in. They switched from pain pills that were much harder to get and more expensive over to he**in. In 2008 and 2009, most of the op**te deaths were from pain pills. By 2011 and 2012 most of the deaths were from he**in. That went on for several years and by 2016, fentanyl came into play. By 2017 most opioid deaths were from fentanyl. So fentanyl has now replaced he**in,” Holmes said.
“It was all driven by economics and cost. Fentanyl does not require large fields of poppies. It doesn’t require a large labor force. He**in is very labor intensive. You need lots of people. Lots of land. You have to grow poppies and process it. It exposes you to a lot,” Holmes said. “Fentanyl you can make in a chemical laboratory. You can get a place the size of this room and manufacture millions of doses of fentanyl. On a kilogram of fentanyl the profit margin is huge because it’s so concentrated.
“The cartels realized, rather than smuggle a kilogram of he**in across the border and make $50,000, you can smuggle a kilogram of fentanyl and make $1 million. Currently fentanyl is the main source of overdose deaths in the United States,” Holmes said. “We have not been as affected by fentanyl as they have on the East Coast but I’ve been told in terms of drug seizures, he**in is getting hard to find in New York. But fentanyl is very easy to find. Drug dealers from an economic standpoint are mostly dealing fentanyl now.”
Police suspect fentanyl may have claimed Corinna Megan Ortega.
Holmes the neighbor and fellow friendly hiller:
The 30-year member of the Whittier Host Lions Club was sponsored by Jerry Perisho and he and his wife, Cynthia, have raised three children, Ethan, Andrew and Courtney and have three grandchildren.
Holmes was drawn to Whittier in 1980 to serve his residency. He and his wife fell in love with the town and decided to stay.
The avid bicyclist and USC grad also serves as medical director of L.A. CADA, a substance abuse help center in Santa Fe Springs.
“I have known Randy for 20-plus years,” said Mark Scott, a licensed advanced alcohol and drug counselor, substance abuse professional and fellow Lion’s Club member. “He’s engaging, empathetic and humorous. I have referred numerous people with a substance use disorder to Randy over the years for help with medications to combat cravings. I have always found him very knowledgeable, open to input and supportive of the recovery process in general.”
Holmes said Cynthia has also been involved in the substance abuse battle. As a member of the East Whittier Junior Women’s Club, she helps out at a women’s crisis shelter near Cal High called How House.
“We’ve enjoyed the community and made a lot of good friends here,” Holmes said. When he’s not practicing family medicine or being an advocate for the dependent he and Cynthia love to travel. The pair just got back from a safari in Tanzania after a stint with friends in Amsterdam.
“I’m just a regular guy trying to make a difference. I don’t see myself as anything more than that,” Holmes said. “I do a lot of stuff, not because I have a particular talent, but just because I’ve been willing to show up and volunteer, to raise my hand. Substance abuse stuff is in my family. So I have a natural affinity for that.
“Coming from a primary care background, taking care of people with drug problems is like managing a chronic illness. Patients relapse, then they come back for more treatment,” Holmes said. “You don’t boot people out if they relapse and start using or drinking again. It’s like diabetes or hypertension or asthma. A lot of these chronic illnesses really don’t go away. You just say, ‘Come back. Let’s talk.’”