Health Alert
GUIDANCE AFTER PAIN MANAGEMENT PHYSICIAN’S LICENSE SUSPENDED

The Division of Public Health (DPH) is issuing this health advisory to make health care providers aware that the Delaware Secretary of State in conjunction with the Delaware Board of Medical Licensure and Discipline has temporarily suspended the medical license and controlled substance registration of Dr. Damon Cary, effective immediately. The suspension was a result of request made by the Delaware Attorney General’s Office following investigations into the prescribing and treatment practices of Dr. Cary.

There may be former patients of Cary who wish to obtain opioids, benzodiazepines, amphetamines or medication-assisted treatment (MAT) for continuing management of their symptoms. Individuals who may be misusing and abusing prescription medications are at a higher risk of drug-seeking behavior, illicit use of prescription medications and illegal substances and for dangerous withdrawal symptoms, including the potential for overdose or death.

Background

Investigations into the prescribing and treatment practices of Dr. Cary lead the Delaware Attorney General’s Office to request the provider’s license be suspended.

The Board of Medical Licensure and Discipline and the Secretary of State have the authority to temporarily suspend a license pending a hearing, if a complaint concerning the activity of a licensee presents a clear and immediate danger to the public health and safety.

Recommendations:

To help Cary’s patients find appropriate continued pain management care and appropriate medication support, DPH is recommending that:

•  Patients of Cary who were receiving treatment for substance use disorder contact DSAMH’s Mobile Crisis Helpline in New Castle County at 1-800-652-2929, talk with their insurer, or visit HelpisHereDE.com to get connected to new treatment services.
•  Prescribers should evaluate patients for substance use disorder risk as part of any regular clinical visit, but especially if they will be prescribing any controlled substances in general and opioids in particular. A sample opioid risk assessment tool can be found at Help Is Here: https://www.helpisherede.com/Content/Documents/Opioid-Risk-Tool.pdf
•  Consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy under certain circumstances. Abruptly stopping opioid medication is not recommended. Review the Centers for Disease Control and Prevention guidance about tapering at Help Is Here in the Safe Prescribing section: https://www.helpisherede.com/Health-Care-Providers/Safe-Prescribing#intro.
•  If a patient appears to be at risk for substance use disorder, consider alternatives to controlled substances and in the event the use of these medications is unavoidable, monitor their use very closely. To the extent possible, use alternative therapies such as:
  •  Rehabilitative services, physical therapy, exercise and strength training for chronic pain
  •  Cognitive behavior therapy and relaxation techniques for chronic pain and anxiety
  •  Clinically appropriate non-controlled medications including but not limited to:
    •  acetaminophen and/or non-steroidal anti-inflammatory drugs (NSAIDs) for chronic pain
    •  selective serotonin and serotonin and norepinephrine reuptake inhibitors (SSRI and SNRIs) or tricyclic antidepressants (TCAs) for anxiety and chronic pain
    •  atomoxetine (Strattera) and/or guanfacine (Intuniv) for ADHD
  •  For further information on substance use disorder for community members and medical providers, visit www.HelpisHereDE.com. For a list of current locations that offer outpatient, inpatient, detoxification, recovery support, and recovery living, visit https://www.helpisherede.com/Treatment.
  •  To reduce “doctor-shopping” and to check the patient’s history for controlled substances, query the Prescription Drug Monitoring program at https://dpr.delaware.gov/boards/pmp/.
  •  Medical providers and law enforcement should be especially vigilant about potential patient overdoses or those with drug-seeking behavior, particularly in and around Newark and Wilmington where Cary’s practices were located.
  •  Patients should be reminded to lock up all medications or put them out of the way of anyone, including children or pets, who might try to consume them, whether by accident or on purpose. Patients can safely dispose of any unused medications at Delaware prescription medication drop boxes. There are 21 permanent drop boxes at this time. For a complete list of locations, visit www.helpisherede.com.

  Additional information

  •  CDC Guidelines for Prescribing Opioids:
    https://www.cdc.gov/drugoverdose/prescribing/guideline.html
  •  Opioid risk assessment tool:
    https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf
  •  Help Is Here
    www.helpisherede.com

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