Many primary care physicians – the top prescribers of prescription pain
pills in the United States – don’t understand basic facts about how people may
abuse the drugs or how addictive different formulations of the medications can
be, new Johns Hopkins Bloomberg School of Public Health research suggests.
This lack of understanding may be contributing to the ongoing epidemic
of prescription opioid abuse and addiction in the U.S.
Since Vicodin was the largest prescribed drug in the United States last year, primary care physicians need to rethink their views on these issues. All it takes is one patient who may suffer from undiagnosed depression or have a hidden addiction issue to change that physicians' professional and personaL life. That includes civil lawsuit, Medical Board problems, and even potential criminal exposure.
Reporting online June 23 in the Clinical Journal of Pain, the
researchers found that nearly half of the internists, family physicians and
general practitioners surveyed incorrectly thought that abuse-deterrent pills –
such as those formulated with physical barriers to prevent their being crushed
and snorted or injected – were actually less addictive than their standard
counterparts. In fact, the pills are equally addictive.
“Physicians and patients may mistakenly view these medicines as safe in
one form and dangerous in another, but these products are addictive no matter
how you take them,” says study leader G. Caleb Alexander, MD, MS, an associate
professor in the Bloomberg School’s Department of Epidemiology and co-director
of the school’s Center for Drug Safety and Effectiveness. “If doctors and
patients fail to understand this, they may believe opioids are safer than is
actually the case and prescribe them more readily than they should.”
He adds: “Opioids serve an important role in the treatment of some
patients. However, our findings highlight the importance of patient and
provider education regarding what abuse-deterrent products can and cannot do.
When it comes to the opioid epidemic, we must be cautious about overreliance on
technological fixes for what is first and foremost a problem of
overprescribing.”
Another finding from the new research: One-third of the doctors
erroneously said they believed that most prescription drug abuse is by means
other than swallowing the pills as intended. Numerous studies have shown that
the most common route by which drugs of abuse are administered is ingestion,
followed by snorting and injection, with the percentage of those ingesting the
drugs ranging from 64 percent to 97 percent, depending on the population
studied. Certain medications are more likely than others to be snorted or
injected.
Prescription drug abuse is the nation’s fastest growing drug problem,
according to a report released by the White House in 2011. According to the
U.S. Centers for Disease Control and Prevention, prescription drug overdose
death rates in the United States have more than tripled since 1990 and have
never been higher. The clinical use of prescription opioids nearly doubled
between 2000 and 2010. By 2009, prescription drugs surpassed motor vehicle
crashes as a leading cause of unintentional death, with more people dying from
prescription opioids than cocaine and heroin combined.
“Doctors continue to overestimate the effectiveness of prescription
pain medications and underestimate their risks, and that’s why we are facing
such a public health crisis,” Alexander says.
For the study, Alexander and his colleagues conducted a nationally
representative survey of 1,000 primary care physicians between February and May
2014 examining their knowledge, attitudes and beliefs regarding prescription
drug abuse.
They focused not only on opioid abuse and diversion (the use of
prescription drugs for recreational purposes), but also their support for
clinical and regulatory interventions that may reduce opioid-related injuries
and deaths.
The researchers found that all respondents believed that prescription
drug abuse was at least a small problem in their communities, with more than
half reporting it was a “big problem.” While there was disconnect in
physicians’ understanding of some elements of abuse and addiction, the
researchers found large support for a variety of measures that could reduce
prescription opioid abuse.
Nearly nine out of 10 physicians said they “strongly supported”
requiring patients to get opioids from a single prescriber and/or pharmacy,
something that would cut down on the number of patients who go from doctor to
doctor to get more pain pills than one doctor would prescribe.
Two-thirds of doctors strongly supported the use of patient contracts,
where patients agree to properly use their pain medication and not give or sell
it to others.
More than one-half strongly supported the use of urine testing
for chronic opioid users to make sure patients are taking their medication and
not diverting it and are not taking drugs they are not prescribed.
Alexander says he is heartened by the numbers, but believes some
physicians may be overstating their support for such measures, as they would be
time-consuming to implement and, in the case of urine testing, are already
recommended by some guidelines yet typically underused.
Attorney Commentary: Compliance, training and new procedures are key. The world of prescribing has changed. Have someone outside your practice evaluate your prescribing, documentation and efforts to confirm prior diagnoses, prior prescriptions to patients, screen for drug abuse and minimize risk. It is good for patients and for your own professional practice. This is healthy risk management. Have patient contracts and create new procedures for anyone receiving pain medications - even if just for a short term problem.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
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