WhiteCoat

Blaming doctors for prescription drug abuse

pill_pills_264112_lAn article written by two physicians in Time magazine 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?

16 Responses to “Blaming doctors for prescription drug abuse”

  1. Annette says:

    This doesn’t even touch the trend that I’ve seen as a nurse for those bad apples who can’t get prescriptions – they’re now turning to meth & (increasingly) heroin. Keeps the MDs’ hands clean, which is a very good thing, but shows that folks will find what they want one way or another.

    But, yes, those who truly are in pain and whose physicians refuse to turn to narcotics do suffer. Makes me think of the spunky little old lady who nearly died of a GIB from too much ibuprofen trying to control her debilitating arthritis pain…she’d had blood transfusions every few months for the prior six months or so, but the doc never figured out the reason for the anemia(she swears he never even asked her about her OTC meds). She’s one of the ones who could have been better served with judicious narcotic use.

  2. throckmorton says:

    One of the first laws of trauma: Pain does not kill, pain medication does.

    Pain is not a vital sign

    • Pain says:

      Pain can kill. For example, a post-thoracotomy patient with poor pain control can hypoventilate, leading to atalectsis, pneumonia, intubation, etc.

      Or a post op patient who doesnt ambulate because of pain, gets a PE and dies.

      I agree that pain isnt a vital sign, but its still important to manage.

      • throckmorton says:

        I agree that it is important to manage but narcotics are not always the option. I cant tell you how many times I have had to come and give narcan to the pots VATS on the PCA. There are other ways to help decrease pain such as toradol and other agents. It is one thing to manage pain, it is another to make pain free. the somnolent over narced patient doesnt do much except hypoventilate and die.

  3. Lisa K. says:

    Due to an assignment at work, I’ve been researching pain contracts. Can anyone give me any real life examples of the use of pain contracts in medicolegal situations? Did the pain contract protect the doctor or did the doctor get into trouble despite the pain contract?

  4. girlvet says:

    How refreshing that a doctor would be honest about this subject. Its the first step in changing a massive problem.

  5. SeaSpray says:

    Why would a patient die from using prescribed pain medication? Or are you talking about addicts who overdose?

    • pete says:

      Even properly prescribed meds carry a risk of overdose and death. Patients don’t always follow instructions. Patients double up with other meds. Patients doctor shop and are prescribed the same meds twice and take both as directed. A doctor doesn’t know what’s happening when the patient leaves the office.

      • SeaSpray says:

        Thank you – I did figure that, but I thought even if taken normally and doctor aware of all meds. That there was something inherent in the use of it even under the best circumstances.

        if I get a new med for anything …even an OTC (cold med) product…I have a habit of ALWAYS running it by my pharmacist …even eye drops.

    • throckmorton says:

      The pain medications kill by different mechanisms. Repiratory depression and automobile are the most common. Respiratory depression only kills the person taking too much of the medication where the automobile tends to also kill others.

      I am always amazing the number of people who are out driving while taking oxycontin, hydros and percs. Not to mention xanax for their nerves, flexeril for their back and a few Buds thrown in for good measure.

  6. Matt says:

    “there’s a decent chance they’ll be dragged through administrative and legal proceedings regarding the death.”

    Interesting claim. What is the chance? 20%? 10%? 80%? Do tell.

  7. Ron Miller says:

    That case is not going anywhere. Because it is dumb. But you can change the facts around and I could buy into it.

    • WhiteCoat says:

      Ron,
      Which case?
      If you Google “physician criminal charges patient death”, you’ll get 14 million hits.
      Even if such cases go nowhere, the physicians are threatened with incarceration, license loss, and have to pay for criminal attorneys to defend them.
      Then, after several years, prosecutors can shrug their shoulders and dismiss the charges. Physician ruined.
      Same thing is happening with criminal prosecution of attorneys as well.
      Look into it.

  8. Millie Andreasen says:

    As a patient that suffer from intractable pain, I can’t believe that Doctor’s will actually leave a person to suffer in pain because they are afraid of the patient over dosing, what about patient education? What about medication contracts that put the responsibility on the patient? I understand that there are a LOT of people that abuse these medications, but there are thousands if not millions of people like me, that suffer from chronic or intractable pain that depend on these medications to live a semi normal life, what about us?? What ever happened to “do no harm”? I believe that there should be a balance between prescribing and over prescribing, there should be a balance were a person that goes to an ER with chronic pain will be treated like a human being and not an addict. I know and understand that Doctor’s; specially emergency physicians are in a very tough position, because they don’t know the patient’s history, habits, etc. but the alternative is in-human! Even a dog will get pain relief if needed, so why can’t we??

  9. Jeanne Hyatt says:

    Though I acknowledge that there is a problem for doctors and understand the need for controls, the problems suffered by the legitimate patients because of this mess are overwhelming. For over a year now legitimate pain patients in Florida have not been able to get their legal prescriptions regularly filled at their local pharmacies due to pressure on pharmacists by the DEA. I cannot begin to tell you of the difficulties that have ensued because of this situation by the patient being unable to continue regularly on their therapy but I am sure that a lot of the legitimate patients are ending up in the ER because of them. http://www.abcactionnews.com/dpp/news/region_pinellas/critics-claim-pain-pill-legislation-creates-obstacle-course-for-law-abiding-doctors-patients

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