The FDA is about to get serious on inappropriate prescribing of narcotic pain medications.
What exactly they’re going to do is unclear, but as reported in the NY Times, it “will result in further restrictions on the prescribing, dispensing and distribution of extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets.”
Part of the problem is that some patients who present with musculoskeletal injuries or sprains are inappropriately given a fentanyl patch or Oxycontin.
However, there is also a problem at the other end of the spectrum, where some doctors do not want to deal with the issues surrounding chronic narcotic use, and simply won’t prescribe any narcotics, or refer every pain patient to a pain management specialist.
I suspect that if these doctors were somehow restricted from prescribing narcotics, there would be a sense of relief, now with a built-in excuse for refusing a patient request for Oxycontin.
Duncan Cross comments from a patient perspective, and sees two outcomes: “If this helps ensure that patients who need these drugs – and only those patients – get them, then it’s a good thing. If like every other federal initiative on the issue, this has a chilling effect on physicians’ willingness to prescribe narcotics, then it’s a bad thing.”
I agree with his take, and indeed, the upcoming restrictions will likely result in the latter scenario.
Related posts:
- Why primary care doctors shouldn’t be pain specialists
- Treating chronic pain with narcotics and avoiding the risk of addiction
- Patient satisfaction vs pain relief
- The next instant narcotic
- Are doctors pressured to prescribe opiate drugs?
- "It is a bad time to be in pain"
- Glenn Beck
{ 7 comments }
I usually just tell patients I’ve never written for Oxycontin or a Fentenyl patch and never will, and and therefore they will have to go elsewhere if they want that particular medication.
yeah alot of patients pain clinic shop so you have to be careful
That’s ugly, telling your patients you won’t prescribe oxycontin or Fentanyl, no matter what.
Those long acting medicines are better at managing pain, even “musculoskeletal pain” scoffed at below, and useful at preventing patterns of use that cause addiction.
Prohibition never worked and neither will this. It will only make it harder for legitimate patients to get this medication. What drug will be next….?
Kevin I checked out your link.
Duncan Cross comments from a patient perspective: “…..One of the most frustrating problems with health care in this country is the paranoia and ignorance surrounding pain and pain treatment…..”
Anyone who thinks this is not a problem in other countries is living in a dream world. The doctors go through the same problems with their own medical boards, the patients have their access problems, and prescription drug abuse is on the rise everywhere.
It seems from what we learn in school is that if you are prudent in how you prescribe narcotics, look for signs of dependence versus tolerance versus addiction, then you can appropriately prescribe. Also, for instance, if you have patients presenting with fibromyalgia or chronic pain conditions whereby it is difficult to ascertain the cause of the pain, wouldn’t it be smarter (in terms of risk management with DEA) to have them referred to a neurologist? With that said, you could limit your scope of CII prescribing. Also, note from what I was told in my law course, CIII – CV prescribing is being tracked as well.
Also, I don’t understand what the scare is in terms of treating pain if you use appropriate agents. So, your more placebo type drug being Darvocet n-100, to tramadol (partial Mu agonist), to your hydrocodone/APAP combos, to other partial MU agonists, then to your natural opiods, and synthetic hi-potent agents like fentanyl or sufentanil.
And let’s say a patient starts asking for stronger and stronger pain medications. Well then you can make the decision to refer the patient to a neurologist or pain clinic or decide to increase the strength along the lines indicated above.
So for example if a patient was in a car accident, which is affirmed, you go ahead and prescribe a controlled drug knowing that the patient, once recovered ought to be weened off the medication and hopefully should not be dependent on it.
A whole category of MDs/DOs should not lose “scope of practice” just because of a few dirty or inexperienced docs. If you follow some basic rules with patients it will expose bad behaviors which can then be dealt with by frequent office visits and contracts signed by patients. Narcotics should never be prescribed over the phone without office visit and no refills should be given after hours for any reason, any change in dosage or medication should require an office visit. Mid- level providers should not have that type of scope of practice to presribe narcotics or psychotrophics and Urgent Care and Hospitals should send records to PCPs and encourage patients to see their PCP asap for further evaluation (as PCPs will know if patient is “drug-seeking”). Hospitals should have a policy of letting PCPs know if patient is continually coming in with “drug seeking” behavior. Pharmacists should let prescribing physicians know if they have filled the script by another physician within the last few days. Med legal already encourages physicians to have patients on narcotics with signs of addiction to sign contract.
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