Have you ever had a prescription altered? I have, several times — all opioids. Despite making copies of every prescription to prove what I actually wrote for, dealing with everything from patients who threatened to sue me for false accusations to time spent with the DEA was a real pain. The good news is that during the pre “pain as fifth vital sign” era at least — since my prescribing habits were nominal — the process was handleable. I attribute this to the fact the prescribing decisions were entirely between me and my patients and no one else.
All that changed after so-called “experts” decided they knew better and started pressuring physicians to become more liberal with narcotics. I am proud to say that my narcotic prescribing did not change despite enormous pressure to do so. Strangely, at least in the beginning, I did not see one altered prescription. Perhaps it was because with liberal prescribing came more lax enforcement, so prescriptions were still being altered but were not caught. In any case, the disaster that ensued was so predictable a child could see it. The fact that our leadership went along with it was particularly galling.
In any case, physicians are now dealing with pressure from the exact opposite direction. We have passed through the eye of the hurricane, so to speak. Those storms are clearly getting worse, and if physicians are not careful, we will be the ones suffering the most legal and professional damage, especially since the government has gotten on the bandwagon. In typical politician fashion, the government is now claiming it is going to step in to “fix” the opioid crisis. That means they will be looking for scapegoats. That means lawyers will inevitably follow.
Despite one lawsuit in West Virginia against JCAHO, the current wave of lawsuits is against pharma and pharma chains. Of course, they will vigorously defend and inevitably that defense will be that they are not prescribers. Since politicians need to prove to the public they are doing something, and lawyers really don’t care where their pound of flesh comes from, that means the hammer will inevitably come down on physicians.
So far the pressure on physicians has been regulatory. Some logical moves like strengthening pharmacy prescription tracking but some overreaching like blanket limitations on narcotics and some ridiculous like pain contracts.
Improvements may come from increasing addiction treatment, but the high recidivism rate may limit that success. What will physicians do when the government suspends their license on the mere suspicion of inappropriate narcotic subscribing? What happens when the lawsuits start? I suspect that our leadership will do nothing — which, once again, leaves us to fend for ourselves. For me, I have decided to go on another “micro strike.”
I have decided to stop prescribing narcotics altogether.
Granted, my current position allows me to do that and surgeons can’t stop altogether, but even they can have strict rules regarding their narcotic prescribing.
I call on other physicians to do the same. We can’t afford any additional contributors to burnout and narcotics are just too radioactive to touch right now. If we tell our patients it is our blanket policy, they will have to accept it.
It’s time for physicians to send a clear message that we will no longer be political scapegoats or ATM machines for lawyers. With enough luck we may be able to achieve what is needed and to return to the pre- “fifth vital sign” era where pain control decisions were between physician and patient and no one else. Limit the government intervention to going after the pain mills where the real problems are and leave the rest of us alone.
Then I could return to the one narcotic prescribing problem I had, dealing with the occasionally altered prescription. Still annoying — but a small price to pay for being a physician again.
Thomas D. Guastavino is an orthopedic surgeon.
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