Laurence M. Deutsch and Steven E. North
"The opioid epidemic" has received much press attention lately. This is a significant national health problem: An estimated 59,000 Americans died from opioid related causes in 2016.
There have been some recent high-profile prosecutions of physicians who have allegedly filled fake prescriptions for patients in the manner of a drug dealer. Dr. David Taylor, for example, a pain management specialist was recently charged with running a "pill mill in Staten Island."
The vast majority of excessive opioid prescriptions, however, do not appear to be the result of such direct criminal activity. Rather, new sources suggest, and our own anecdotal experiences reinforce, many opioids are simply over prescribed by doctors who may lack the requisite training or sensitivity to the issues.
It is an unfortunate dynamic that some patients in chronic pain, sometimes resulting from medical malpractice, may need ongoing prescriptions of strong pain-relieving medications. Often the most effective medications, opioids, are also addictive and carry multiple risks including overdose. Some patients have overdosed using so-called pain patches that contain powerful medications such as Fentanyl, which is often used by anesthesiologists to put patients to sleep during major surgeries.
It is easy to understand that a patient may think that a pain patch can’t be very dangerous because it is not ingested or injected. Nonetheless, there have been many unfortunate cases in which patients were given overdoses via Fentanyl pain patches.
The broader problem of opioid overuse in the United States has many causes including illicit drug dealing through physicians’ offices or black-market prescription of opioid pharmaceuticals. It is our opinion, however, that the wider problem exists in terms of simple over-prescription or excessively long-term prescriptions of powerful pain medications by physicians who lack the training to properly prescribe these powerful medications. It is far too easy for a physician to prescribe additional medication to a patient who reports ongoing pain – and who then does not attempt to wean the patient from it or send him/her to specialists for that purpose.
The field of "pain management" is often misunderstood in this context. Pain management physicians are actually specialists in achieving the lowest effective dose of pain medication. They are often appropriately involved with patients who have an ongoing need of significant pain control. It is our belief that patients would benefit more from being referred to pain management specialists when they have significant ongoing pain-control needs than given more medication.
Part of addressing the opioid crisis requires better training and sometimes better enforcement in the medical profession to be sure that physicians are not overprescribing for their own convenience or out of a lack of knowledge about specialists who can limit patients’ use of such dangerous medications.1
1“Doctor Arrested in New York on Opioid Charges Signals Federal Crackdown on Pill Epidemic,” Newsweek, June 23, 2017.
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