The cost of blaming doctors for prescription drug abuse

The cost of blaming doctors for prescription drug abuse

An article written by two physicians in Time questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications.

There are two frames of reference to this article.

First, no one can argue that prescriptions for pain medications in this country are excessive. The article notes that in 2011, “enough hydrocodone was prescribed to medicate every American around the clock for a month.”

As both authors are emergency physicians, the end of their article notes that “we must stop fearing patient-satisfaction surveys and talk honestly to our patients about pain.”

Ask most emergency physicians and they will tell you that satisfaction surveys pressure physicians to overprescribe multiple medications, including antibiotics and opiates.

But where do all the medications go?

Note how many commenters to the article are upset because they or their family members are having a difficult time obtaining pain medications for their chronic medical problems.

Doctors are becoming increasingly aware that if they prescribe pain medications to a patient who dies, there’s a decent chance they’ll be dragged through administrative and legal proceedings regarding the death. So doctors then learn to fear the bad outcome and then take steps to avoid the bad outcome. Doctors can’t get sued if they don’t prescribe the pain medications.

Patients in legitimate chronic pain are paying the price – and it isn’t just in the emergency department, either. From the comments:

“… their physician won’t see them anymore because they need stronger pain medication …”

“His GP won’t prescribe, his GI won’t prescribe, the pain clinic keeps trying to push him into treatments that DO NOT WORK for his disease.”

“… the ER staff will still stand around and pretend like opioids don’t exist and it’s okay to let the patient lay there in pain …”

Reminds me of a post I wrote nearly 5 years ago. Only this time, the solutions that our governments are proposing seem to be adding to the problem.

When we vilify, sue, and criminalize doctors whose patients die from medication overdoses, fewer and fewer doctors are going to be willing to prescribe pain medications.

I’m predicting that we’re going to see a downward trend in the amount of pain medications prescribed. The threat of incarceration is going to outweigh the threat of bad satisfaction scores.

And we’ll all be “safer” through more regulations, bad press, and blaming physicians for the bad apples … right?

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

Image credit: Shutterstock.com

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  • doc99

    Is anyone compiling statistics on the collateral damage of the hurdles placed on prescribing opiods – the number of patients unable to get relief, etc?

    • ninguem

      Tough to get stats like that. Because I **will** do medical pain management, I also get patients who misprepresent their story. I mean the previous doc won’t prescribe for good reason. Diversion, multiple prescribers, criminal activity, selling drug, arrests for various offenses repeatedly.
      Three new patients with that sort of story, just this month.

      • NormRx

        I can’t believe patients lie to their doctor. You mean when a doctor ask a patient if he smokes, how much he drinks, his/her sexual habits, DOES HE HAVE A GUN IN THE HOUSE they might not tell the truth? Well, I never.

  • poloalb@aol.com

    Lack of education
    is one of the biggest problems. The majority of patients falls under the
    category of good behavior and follow the doctors treatment plan.

    Implementing an educational model about the types of medications and their
    consequences could be a good step to patients, family members, society and
    physicians. The managing of side effects, patient responsibility, a logging
    system for setting goals, patient pain diary and a very forceful treatment
    agreements. Addiction specialist should be part of a pain management practice
    as well as psychiatry. Physicians should be protected bythe federal government.
    I understand your pain… not easy for any doc

  • brijikins

    I wonder about the future of physicians??…….. litigations! Predictions anyone?

  • buzzkillerjsmith

    This stuff goes in cycles. Medication great, let’s prescribe more. Medication bad, let’s prescribe less.

    Right now ADHD meds are having their day in the sun. That will pass as society gets freaked out by all the prescription crankheads who are inevitably coming down the pike. Round and round it goes.

  • Hornblower1810

    Has anyone noticed that as the “war” on prescription Rx intensifies the “war” on Mexican and Columbian drug lords just floats to the background. DEA agents and LEO’s are one hell of a lot safer arresting M.D.’s than going after real drug dealers. And best of all the local DA’s and pols can still run their next political campaign showing how “tough on crime” they are. Of course it’s a farce but the American people on average are amazingly gullible. Or maybe I’m just getting cynical in my old age.

  • meyati

    “… the ER staff will still stand around and pretend like opioids don’t exist and it’s okay to let the patient lay there in pain …” I’m not talking about chronic pain-I’m talking about trauma

  • poisonalice

    This is more like a war against chronic pain patients than illegal drug use. I’m lucky enough that I’ve been seeing my PCP since I first got injured, so he knows everything that I’ve been dealing with over the past 11 years or so, but even with the high dose of medication I’m on, I’m still limited to the *types* of pain medications I can have. I don’t totally blame doctors, I understand they’re in a tough spot. And the DEA should have NO say over PRESCRIPTION pain medications, until they’re on the streets ILLEGALLY. But there are also an entirely too high amount of doctors who will not prescribe opiate pain medications AT ALL, no matter their patients individual situation. I’m allergic to all NSAIDs,have tried various forms of PT, did the injections, even nerve ablations, to no avail, so I’m one of those patients who is difficult to treat, and I’ve been treated like a liar rather than a unique, non-average chronic pain patient. I’ve even had doctors try to convince me to go off of ALL of my medications, including medications like Lyrica and Celexa (which I’m no longer on, having switched to other medications), and try doing yoga and adjusting my diet, like that’s going to magically get rid of my pain, like I haven’t tried it before. I think the people I blame the most are the DEA (or the government in general) and the media for the current treatment of chronic pain patients who need and use opiates to control their pain levels. Only a small percentage of chronic pain patients on chronic opiate pain medication become true addicts. How about the country quits treating pain patients like drug addicts first? That’s how it is. Whenever someone finds out what I’m on and the strength, I’m treated like a drug addict. I’m not. Yes, I’m dependent on my pain medications, but that’s because without them, I can’t function due to the pain. Once the public is PROPERLY educated about chronic pain medication use in chronic pain patients and the reality behind it, perhaps the stigma behind these medications might possibly diminish.

    • Sarah

      You said it! Thank you.

  • Sarah

    I would really prefer that Mayor Bloomberg is not in the room with me when I visit the ER. I would also appreciate that my treatment is not prejudiced because the patient my doctor believed he/she treated before me was trying to get an opioid specifically in “drug seeking” visit. Number one-Doctors-how do you know a patient is not in pain? You don’t. Secondly-There are millions and millions of under-treated chronic pain patients. Chronic pain is an epidemic. Doctors should treat a patient complaining of pain because the odds are they ARE in PAIN. The pain patient should be treated to relieve any pain for even a day or two and then referred to a Pain Management Doctor. Stop judging. Stop worrying about treating your patients! That’s what you are supposed to do Doctor. Practice Health Care and the oath you took to be a Doctor. It’s the Doctors who needs to stand up and fight for their right to treat as they deem appropriate.