Doctors Struggle with Potential Enabling

doctor prescribing painkillersPrescription drug abuse is an extreme problem in the United States. According to the National Institute on Drug Abuse (NIDA), the United States makes up 5% of the world’s population, but consumes 75% of available prescription drugs. This statistic begins to show how desperate the problem is becoming in this country, where direct-to-consumer advertising has driven demand. In addition to creating a nation full of pill-popping people seeking relief from one discomfort or another, it has also resulted in an alarming number of people becoming addicted to opiates.

As more people become affected by prescription drug abuse, there is a greater demand for answers as to why the problem is so out of control. Many people are happy to point their fingers elsewhere, but there are numerable contributors. One big one happens to be the prescribing practices of physicians. Some people get painkillers directly from their doctor (about 20%), while even more people (about 54%) obtain prescription opioids from family and friends. How can this be reduced from the prescriber’s side?

Allison Bond is a physician at Mass General who has many patients that struggle with chronic or acute pain and would be candidates for prescription painkillers. She recently wrote an article explaining how she struggles every day with deciding whether or not to prescribe drugs with a high potential for abuse such as OxyContin. In her article, she explained that her main concern is the potential for unknowingly contributing to someone’s death. She is aware that this could be from an overdose, or from one of her patient’s selling their prescription. Selling prescriptions is a very real problem, because the demand is so high for painkillers, dealers can make thousands of dollars off of one bottle of pills.

“My task as a doctor is to take stock of each patient’s risk for misuse of the medicines and weigh it against the desire to treat his or her pain. There is an ever-present fear that, as much as I hate to believe it, a patient could be manipulating me,” wrote Bond. Her article starts out with her battling whether or not to continue painkiller treatment on a patient who is begging for more pills. During the time that she sits with him she has to decide what to do and ultimately decides to end the prescription because she feels it would otherwise continue to enable addiction. This type of decision making has become increasingly more common and the responsibility on shoulders of medical professionals is massive.

Bond ends her article by highlighting the importance of trust between doctors and their patients. There are certainly signs to look for when trying to decide if someone is abusing painkillers, such as running out of the prescription much sooner than expected, exhibiting withdrawal symptoms and the presence of other drugs in the person’s system. There are many other signs that patients may abusing their medicine as well, which is one reason why there is a push for more doctors to be trained in addiction medicine. Having a better understanding of symptoms and behaviors associated with substance abuse, along with actually using the prescription drug monitoring programs, can help physicians make better decisions about prescribing narcotics.

Mike Loverde

With firsthand experience with addiction, Mike Loverde is now a Certified Intervention Professional (CIP), as accredited by the Association of Intervention Specialists and the Pennsylvania Certification Board. He founded Family First Intervention in 2008 and has since helped hundreds of families find intervention and addiction rehabilitation solutions.

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