Prescription drugs are one of the biggest crises that face the medical community today. On the one hand, why would a doctor not prescribe a strong painkiller for someone dealing with severe pain? On the other, we have the highest incidence of prescription drug abuse than ever before, and many states have actually declared a state-wide crisis.
Can we blame doctors?
Doctors are the ones who are writing the prescriptions but are doctors at the root of the crisis? Is blaming doctors putting it in the wrong place? Patients need painkillers. Doctors have a responsibility to stop the pain, there’s a point of alignment here.
The problem becomes tricky when too many painkillers are prescribed over too long a period, especially when the physician should already have realized the inevitability of dependence or worse, addiction.
Where does a dependency start?
A Harvard based study took a look in the prescribing of opioids in emergency rooms. The study group expected a broad range of results, as there are no real guidelines on how to prescribe. The results were broad, but not entirely unexpected.
The high prescribers would prescribe an opioid-based painkiller to one in 4 patients, whereas in the same place, low prescribers gave opioids less than 7% of the time. Averaged out, this carried through to 1 in 48 patients who visited the emergency room becoming a long-term user.
This did not include the doctors on internal medicine or other disciplines, but worryingly, it does show that who patients see, a high or a low prescriber, makes a difference to the potential of a long-term issue.
Florida is one of the states which recognizes the current state of opioid usage as being at crisis level. As well as declaring a state of crisis, the government has stepped in and now limits the doctor’s ability to prescribe long courses of painkillers to new and ongoing patients. On the whole, patients will receive less than a week’s supply at one time. A patient will also need to revisit the situation with the doctor on a regular basis.
There are obvious exceptions to this rule. Patients with terminal diseases are exempted as are critically ill patients. However, the aim is to get prescription drugs off the streets and to try and limit the number of new dependencies which are created. And so far Florida’s government reports a level of success with the approach.
Tighter guidelines and better education
There can be little doubt that the state-imposed guidelines can make a difference. But just as important is physician knowledge and understanding about over prescribing.
Doctors need to increase the ways in which they are educating each other about the dangers of over prescribing. This does not necessarily mean formal education, although there is an obvious need for thorough training at the educational level.
There is also the need for informal knowledge exchange between colleagues and partners at a practice level. It is the only way I see we can stop the epidemic.