Happy new year! I hope your holidays were great and that 2016 holds all good things in store for you and those you love. The Painkiller Law Blog is back and ready for the new year. Let’s dive right in with a story bizarre enough to push the envelope even in the already bizarre world of the prescription opioid epidemic.
A late 2015 issue of the highly regarded medical society publication, Annals of Internal Medicine, reports that most doctors continue to prescribe opioid painkillers to patients, even after a patient overdoses on the drugs. Specifically, 91% of patients got a prescription from a doctor after an overdose, and 71% received a repeat prescription from the same doctor who’d seen the patient prior to the overdose.
Can you think of any other area of medical practice or treatment where this would happen? Where the worst adverse outcome, as close to accidental patient death as you can get, would be met with a repeat of the treatment or prescription which caused the accident? It brings to mind Mel Brooks’ line from Blazing Saddles, when has asks in Yiddish, “Hobn ir gezen aza a zakh in deyn lebn?” English translation: Have you seen such a thing in your life?
From where I sit, the answer is a resounding “no.” But even more perplexing than the issue itself is why it is happening. I posit the following four reasons:
1. FDA Cluelessness. The FDA doesn’t know what it’s doing about opioids. The FDA is too busy telling pharmaceutical companies to develop abuse-resistant opioids and overdose antidotes. These are good and needed, but they’re only needed because the FDA earlier approved mass prescribing, for chronic pain, of drugs which are now known to be highly addictive and generally not effective. In a sense, the FDA’s response is to continually try and put Band-Aids on a cut the FDA keeps opening.
2. Corporate Greed. The pharmaceutical industry has made billions and billions of dollars off opioid sales, and continues to do so. As long as the drugs are available for prescription for chronic pain – and with millions of patients addicted to painkillers, there’s no feasible way to simply stop allowing mass prescribing – Big Pharma has absolutely no incentive to do anything about the problem it helped create and from which it continues to profit.
3. Patients’ Over-reliance on Painkillers. Patients have to be their own best advocates and demand real solutions to their pain, not just drugs which mask symptoms until the medicine wears off, and whose dose has to be increased to bring even temporary relief. Opioids don’t attack the source of pain; they don’t address an underlying medical problem. There is no substitute for physical therapy, or surgery, or many other forms of treatment aimed at addressing the root cause of a medical problem. Pain patients need compassion, support, understanding and help, and they need to participate in helping their doctors isolate and treat an underlying, root-cause medical condition.
4. Doctors’ Ignorance and Poor Decision Making. When 71% of patients are getting refills of an overdose-causing medication from the same doctor who originally prescribed, something is amiss in the medical profession. Too many doctors went into pain management with insufficient training and knowledge. Too few doctors undertake a real assessment of the efficacy and appropriateness of prescribing opioids, before they prescribe. Too many doctors persist in their ignorance and get lazy when it comes to refilling a scrip, versus really helping a patient get better. And, too few doctors know and follow their state’s guidelines for prescribing controlled drugs. Doctors don’t bear all the responsibility, and they did not create this public health crisis, but they play a role in its perpetuation. If a doctor is going to prescribe opioids, he or she has to know the criminal law, and follow it, or else the doctor will be placing herself and her patients at risk.
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