How Could Doctors Play Their Role in Reducing the Opioid Epidemic?
Doctors played a decisive role in fueling the opioid epidemic whether they knew it or not.
A study done by the Boston Medical Center earlier this year and later summarized in Medium found that unscrupulous opioid marketing tactics coupled with excessive practitioner prescribing created the surge we all saw in opioid addiction years ago and have been seeing ever since.
The research showed that the doctors who were prescribing the most painkillers to patients were the same ones receiving maximum attention from pharmaceutical companies.
The doctors who prescribed the most painkillers were also doctors who received cash incentives, free meals, honorariums, expense-paid travels to speaking gigs and committee meetings, etc.—all at the expense of pharmaceutical manufacturers.
Clearly, there are some highly suspicious and even illegal and certainly unethical activities occurring within the medical industry. We have to change this as we are becoming an addicted nation because of it.
It’s Not All on Our Physicians
Let’s remember, physicians are not the only ones who contributed to the opioid epidemic. In fact, they were not even the primary cause of it.
In an article on U.S. News, Dr. Tomas Villanueva discussed how the Joint Commission imposed pain scores as additional vital signs for hospitalized patients. This created an added incentive for doctors to “address” patient pain and pharmaceutical companies were quick to present opioid painkillers as a “solution” to that pain.
Dr. Villanueva talked about how patients had (and still have) a direct influence on Hospital Consumer Assessment of Healthcare Providers and Systems survey results. And thus patients can actually tarnish a doctor’s good name if he does not prescribe readily-available painkillers to them. Dr. Villanueva touched on how the Centers for Medicare & Medicaid pressured doctors into meeting “medication quotas” for certain types of medications.
Medication quotas? Pain as a vital sign? Patients essentially blackmailing doctors into giving them meds? What is going on here? Since when did medication go from being a “when-needed” prospect to a race to see how many people we can get on meds in as little time as possible? Something is very off here.
Who Is Best Suited for Curtailing the Opioid Epidemic?
Ending the opioid epidemic is a responsibility we all bear. It’s simply not fair to say that, just because one is in a profession which could curb opioid use, the job is “all on him.” The opioid crisis has gotten so out of hand that this is now a job that we all share.
However, doctors are in a great position to do something about opioid addiction—and do something they should.
The opioid epidemic started with the overprescribing of painkillers and the resulting addictions to those painkillers. The first step doctors can take is to simply prescribe painkillers less, and to work with their patients to find non-pharmacological methods of treating their pain.
The doctor should also get educated and help provide treatment to get their patients off the opioid when it is no longer needed. This might be as simple as a good nutrition protocol or even a referral to a drug rehab program.
Preventing Doctor Shopping
Prescription Drug Monitoring Programs (PDMPs), are programs which help doctors and government officials alike prevent “doctor shopping.” Doctor shopping is where a patient seeks help from multiple doctors at once, attempting to get prescriptions from all of them.
“PDMPs collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. Prescription data is provided only to entities authorized by state law to access the program….”
The Prescription Drug Monitoring Program Training and Technical Assistance Center perhaps defines it best, indicating that “PDMPs collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners.
Prescription data is provided only to entities authorized by state law to access the program, such as health care practitioners, pharmacists, regulatory boards, and law enforcement agencies.”
PDMP programs are now available in all states. However, it is not mandatory for doctors to use them. It is voluntary. Doctors should use this aid which offers great potential benefits for spotting doctor shoppers and monitoring the over-prescribing of opioids.
Doctors Should Prescribe Opioids for Shorter Durations
Doctors should not prescribe an opioid painkiller for acute pain for more than three to seven days, rarely more than seven days. This recommendation comes directly from the Centers for Disease Control and Prevention in their “Guidelines for Prescribing Opioids for Chronic Pain.”
The CDC also advises doctors on how to approach chronic pain, and their words are so hard-hitting that they deserve citation here.
The CDC document states: “If benefits (of long-term opioid prescribing) do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.”
Another note from the CDC is particularly worthy of mention. Front and center in the first guideline from the CDC. It states: “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. … If opioids are used, they should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.”
Direct from the federal organization in charge of keeping America’s health on track is the bold message that doctors must curb their prescribing trends.
Doctors Must Be Ready and Willing to Refer Patients to Treatment Centers
Doctors have to be ready to refer a patient to an addiction treatment center if it is clear that the patient is hooked on opioids.
It is a poor interpretation of the Hippocratic Oath that makes a doctor think he should keep prescribing an addict his opioids, merely because “the addict is in pain.” A better solution would be to refuse to prescribe and to instead ensure that the addict-patient gets into a treatment center.
To play the Devil’s Advocate, some doctors will protest this notion and say, “But then my patient might just go use heroin instead. Then he’ll surely die.” A legitimate concern. But if a doctor refuses to continue prescribing opioids to a patient who is clearly hooked on them, there is a strong chance that patient will get help by entering addiction treatment. If the doctor keeps prescribing opioids, there is no chance.
This Is a Task Shared by All
“Despite all the political rhetoric and additional state and federal mandated pressure, the heart of the matter is a simple truth. We, as health care providers, can prevent future addictions from happening….”
Dr. Villanueva said it best in his closing statements from his letter to U.S. News:
“Despite all the political rhetoric and additional state and federal mandated pressure, the heart of the matter is a simple truth. We, as health care providers, can prevent future addictions from happening. By concentrating on the reason that leads most of us to choose to enter the health care profession (to make a difference in our patients' lives), we can take direct actions that prevent injury while allowing patients to participate in their care.”
And that’s what it all comes down to. The field of medicine is about doing what’s best for the patient in front of you. Now that the opioid epidemic has risen to engulf millions of Americans, we as citizens have to rise up and help doctors battle this crisis.
We have to help the people in front of us, not serve the money-grubbing desires of multi-billion-dollar pharmaceutical corporations.
We are people, not dollar signs.
Sources:
- https://medium.com/@alleodozi/physicians-lured-by-drug-companies-fueling-opioid-crisis-says-study-81322262d6bd
- https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2681059
(The Medium article cites the Jama Network research paper. A subscription is needed to view the original research paper on Jama. No subscription is needed for Medium.) - https://health.usnews.com/health-care/for-better/articles/2018-12-17/how-doctors-can-help-solve-the-opioid-crisis
- https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf
(Item #6 on page #2 of the CDC PDF)
Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP
