With prescription painkiller abuse rampant among teens and adults alike, everyone’s trying to escape the blame-game. From pharmaceutical companies to government agencies, it seems the responsible parties are more willing to throw money at the problem than address the underlying causes. It’s time to take a closer look at one of the most elemental factors in this disturbing trend: addicted patients and the doctors who get them that way.
Accountability on the rise?
Last week, three U.S. doctors were accused of over-prescribing highly addictive painkillers such as OxyContin that have been linked to patient overdoses and even deaths. While it’s not unprecedented for doctors to be held accountable for such occurrences, it is unusual. And the fact that three similar, unrelated incidents took place last week makes us wonder: are doctors’ over-zealous prescribing practices finally getting the attention they deserve?
It’s significant that in each case, neither the doctors nor those receiving the prescriptions were found to be illegally distributing the drugs. In other words, the doctors were careless with their prescription pads, and the patients were uneducated in the dangers of the drugs they were taking.
In attempt to point the finger, “pain management specialists” have received increased scrutiny from federal authorities and the media in recent years, according this article. But convictions are sporadic at best, and in most cases, careless doctors receive a slap on the wrist rather than jail time.
What’s more, in states like Florida, efforts to implement prescription monitoring programs receive more attention (albeit in the form of criticism and fiscal delays) than the doctors who are directly contributing to their patients’ deaths.
Many state medical boards have adopted guidelines for prescribing controlled substances in the treatment of pain, according to this document from the Federation of State Medical Boards. The federal Drug Enforcement Agency also sets forth guidelines and regulations which tend to be less stringent than those of state medical boards.
All these regulations stipulate that upon patient evaluation, the doctor must create a treatment plan, perform periodic reviews and consultations, keep medical records, and be in compliance with controlled substance laws and regulations. But they don’t stipulate the amount of drugs that should be prescribed.
For instance, according to California’s pain management guidelines, “there is not a minimum or maximum number of medications which can be prescribed to the patient under either federal or California law.”
The amount of pain medication prescribed is left to doctors’ professional judgment. Meanwhile, they are constantly being influenced by pharmaceutical companies to prescribe certain drugs – and are simultaneously being pushed to minimize their time spent with patients by bottom-line minded insurers.
All that pressure amounts to highly addictive Schedule II narcotics being handed out like candy to ensure patients aren’t routinely coming back for more as needed. This behavior results in leftover pills hanging around in medicine cabinets, and in patients becoming inadvertently addicted.
Doctors or drug dealers?
Most people who become addicted to pain medications do so only after they or someone they know receives a prescription legitimately after an injury, or due to chronic pain.
According to the 2009 National Survey on Drug Use and Health, among persons who used prescription drugs nonmedically between 2008 and 2009, over half reported receiving the drugs from a friend or relative. Of those, most indicated that a friend or relative had obtained the drugs from one doctor. Another 18 percent reported that they received the drugs from a prescription from a single doctor. Of those who did not receive the drugs through a prescription or through a friend or relative, about 20 percent stole or bought the drugs from someone who had a prescription; only a very small number obtained the pills from drug dealers.
In other words, the main drug suppliers to the 16 million Americans abusing prescription drugs are doctors themselves.
In Canada, our highly-addicted neighbor, a recent study found that prescribing practices of opiate painkillers vary greatly among family physicians, indicating the lack of consensus among doctors in terms of how much is enough.
The source of the problem
The DEA, along with the privately-funded Community of Anti-Drug Coalitions of America, recently announced the second national Prescription Drug Take-Back Day to provide a safe, legal method to dispose of unwanted prescription drugs. Though local drug disposal efforts have been underway for some time, the White House only recognized their importance last year when it amended the Controlled Substances Act to make disposing of prescription drugs easier for the public.
Prescription drug take-back days exist because a large enough number of people end up with excessive amounts of painkillers, and have no clear method for disposal. This occurrence of patients receiving too many pills provides easy access for would-be abusers. And although the Federation of State Medical Boards reports that many pain management guidelines have been amended recently to reflect the growing problem of prescription drug abuse, legal accountability for doctors remains spotty.
In the case of Florida doctor Mark Round and Oklahoma physician Mickey Ray Tyrrell, hefty fines, license suspension and community service are the maximum penalties. However, for Nevada doctor Richard Sy Teh, murder charges are in the works.
Watchdog’s take: with the evidence suggesting that the root of the prescription drug abuse epidemic lies in the examination room, more severe penalties for careless doctors are essential. The likelihood of criminal charges for any doctor who over-prescribes narcotics would do more to adjust casual attitudes than any number of government think tanks or Big Pharma-funded take-back days.
And while we’re at it, these recent cases also highlight the need for state medical boards to set out more clearly defined limitations when it comes to prescribing Schedule II narcotics.
Consider our finger pointed.
Read about doctors’ ties with drug companies here.
More information on Florida’s prescription drug problem here.
Information about Prescription Drug Take-Back Day here.