HCPLive Network

The Effects of Over-prescribing Medications

An article that appeared in the Washington Post early in January highlights the scrutiny faced by physicians prescribing narcotics to treat pain conditions. The article, “Doctors who prescribe oft-abused drugs face scrutiny” begins with the story of a pain patient Peter S. Trent, who over the course of two and a half years had 275 prescriptions refilled claiming either the pills were lost stolen, etc.
 
The article goes on to present the issue of over-prescribing in pain management and raises questions about the amount of education needed to prevent physicians from prescribing to the wrong patients, how to deal with physicians that have been investigated for prior suspicious drug-prescribing activity, the nature of prescription drugs in managing pain conditions, and the epidemic of misuse and abuse.
 
Lynn Webster, director of the American Academy of Pain Medicine, followed up with a lettor to the editor describing an important outcome of the legal scrutinity placed on pain physicians prescribing opioid analgesics. The title of the letter was, “Patients suffer when doctors are too scared to prescribe pain pills.”
 
In the letter, Webster writes that every American should be concerned “about the kind of message” sent in the Washington Post article.
 
Webster explains that while some of the points are true, mainly that some patients misuse the medications and some physicians carelessly prescribe them despite the abuse, there is an “equally important issue” that was “shortchanged” in the article.
 
“The consequences of inadequate pain therapy are underreported”
 
Webster highlights his own experiences as a pain physicians dealing with patients that are on opioid analgesic treatment who begin to show signs that they may not be benefitting. Like the physicians featured in the piece, Webster said he would begin to lower the narcotic use in some of these patients, because he "wasn’t sure it was helping.” But also, he admits that the “legal and regulatory pressure” also plays a role in that decision.
 
Webster writes:
 
“…The article reinforces those concerns and may well have a chilling effect on prescribing for those who need the medications.
 
Solving the problem of drug abuse and overdose deaths from pain medications will require considerable effort, research and education by all concerned, but it should not stop efforts to effectively treat pain. Nearly every American knows someone who will suffer needlessly if physicians are scared to prescribe narcotics to relieve pain.”

Source: Washington Post
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Is under-prescribing pain medications an overlooked problem? What are some of the factors that play a role in the over-prescribing or under-prescribing narcotics for pain management?
 


Further Reading
Steve Gelfand, MD, secretary of Physicians for Responsible Opioid Prescribing (PROP) responds to recent comments by Drs. Cole and Webster in Pain Management.
Synthetic conolidine could offer an equally effective alternative to morphine without the associated side effects.
Research shows that a minority of family physicians prescribe the majority of opioids to patients with chronic pain.
Primary care physicians rarely use opioid risk reduction strategies, even with patients who are at high risk for misuse or abuse.
Opioid analgesics should not be used in elderly patients with osteoarthritis even if their pain is severe, because the associated risks are so great.
More Reading