Two important news stories came out this past week: One a survey by Johns Hopkins/Bloomberg showing that many doctors don’t understand how opioid prescriptions really work, and one a report by Massachusetts’ governor saying that one way to help stem the prescription drug epidemic is to educate doctors in safe prescribing. Taken together, these two items are cause for optimism and encouragement in improving patient safety and helping doctors not get criminally prosecuted for aspects of their medical practice.
First, the Hopkins/Bloomberg study’s key findings are of concern for anyone who assumes that his or her doctor always knows what’s really going on with pharmaceuticals and the patient’s care. Doctors surveyed didn’t know, for example, that abuse-deterrent pills are just as addictive as non-abuse-deterrent formulations. Doctors surveyed also believed that “abuse” by patients is usually from injecting or snorting an opioid, not from swallowing a pill.
Both of these findings are telling, in my view, because both reflect that even doctors don’t uniformly know prescription opioids’ powerfully addictive properties. Abuse-deterrent formulations are supposed to prevent a patient from, for example, crushing an Oxy-80 tablet to get a powerful immediate dose of a drug that’s normally time-released into the body. What the doctors surveyed don’t get is that the drug itself, not the manner of ingestion, is what can addict people. (Thanks again to the pharmaceutical industry for not telling doctors that part before marketing the drugs as safe and generally non-addictive.)
Additionally, doctors surveyed seem to assume that “abuse” of opioids by patients is done most commonly via snorting or injecting the drug, when in fact most patients who end up becoming addicted or otherwise misusing prescribed drugs ingest the drugs the “legal” way – by swallowing them. That doctors seem to behaviors like snorting or injecting with “abuse” reflects doctors’ naivete about how easy it is for a patient to become dependent or worse on legally approved, lawfully prescribed medication. It also shows a lack of understanding of how even legitimate medical practice can pose risk of harm to a patient when it comes to prescription painkillers.
But the report from Massachusetts governor Charlie Baker is a thorough set of recommendations on how to stem the tide of addiction, overdose and death. Massachusetts in particular has been ravaged by opioid and heroin problems in recent years. Among Baker’s key recommendations is that doctors need to be educated – not indicted, not recklessly targeted or reflexively blamed – but educated in safe opioid prescribing. I have no doubt that any physician practicing in good faith would eagerly embrace and warmly welcome the chance to learn more about how to safely and properly conduct themselves in an important area of medicine. Good for the governor for endorsing physician education, and let’s hope Massachusetts follows through and implements this recommendation vigorously and efffectively.
It’s too early to say that the tide is turning when it comes to blaming doctors for the prescription drug crisis, but this week’s news is very positive in terms of good ideas emerging on how to collaboratively, holistically and smartly tackle a major public health problem.