Not that pharma is angelic here, but don't the doctors have the largest measure of blame for writing unnecessary scripts, failing to monitor for abuse, and failing to encourage alternate options?
I'm in favor of maximum MD power. I think they should be allowed to prescribe everything from cocaine to bleach, or any other chemical compound, as suits the patient care, if they know what they're doing.
But they should also bear maximum accountability for what they prescribe, including abuse potential.
A more helpful line of inquiry to me is the culture of Rx usage. As a society, our patients expect drugs when they go to a doctor and a doctor's average time per patient is around 10-15 minutes. Does not seem like enough time to understand the patient's needs and create an individualized solution. Further, RX medicine is highly profitable and encouraged from the pharma.
In this case it looks like they are incentives for pain pills to be issued on both sides -- money maker for pharma and time saver for doctors (a third side -- convenience and feel good for the patient).
It is not as useful to find so-called bad actors but instead we should evaluate the medical system as a whole and put in safeguards to do less harm. Patients have generally too much influence on doctors for their treatment (otherwise why would direct to consumer marketing exist?), that doctors are not educating patients enough on the risks of narcotics and that pharma has $$ incentive to push medicine. That things like physical therapy and lifestyle changes will better deal with root causes than drugs that only address the symptom (but feel better and are easier to swallow). It's a recipe for a disaster.
I was in a motorcycle accident a few years ago and broke over 10 bones. The worst part of my recovery was kicking my addiction to narcotics. I did not understand what I was getting into and I was never given a path to get off them (not in a coherent way, not until I called to say I was going through withdrawals). This should not be.
Patients tend to give doctors higher customer satisfaction scores when the doctor writes a prescription, regardless of whether the patient really needs it. Patients like to feel that the doctor is taking their problems seriously and doing something. This is one of the negative aspects of moving to a more consumer-driven healthcare model. Providers try to optimize their customer satisfaction scores to bring in more business, and large provider organizations sometimes use those scores as one factor in paying doctors.
I feel your pain, it's scary when you're blind-sided by how deep of a pit you're in. When you realize you're probably in worse shape than the guy on the corner hustling to buy a rock, and you got it from the lady you trust your child's healthcare to. I don't know if it's a willful ignorance, or if many doctors live healthy lives and have no concept of how scarily painful withdrawal is. I can't tell you how many times I've heard it's like having the flu. If people are having flu like that, then it's amazing more people don't die every winter.
Well, there is also information asymmetry at play here. Patients could have legit pain, and then go to multiple doctors, without the others finding out. Then they could sell those to other people, or use them all themselves.
On the other hand, the pharmacies might know, but that could be worked around by a motivated pill-obtainer.
The pharma companies, however, definitely know that they sent 780 million painkillers to a state with only 1.8 million men, women, and children.
I am not saying it is their duty to do something about this, but maybe they have some high-level information that others do not.
I really don't see a way this could be fixed without giving every doctor in the US access to some huge database of every prescription of every person in the country -- which I would not be cool with, nor would anyone else, other than maybe law enforcement agencies.
Between Surescripts providing centralized medication history, and statewide controlled substance prescription registries, doctors can no longer claim ignorance when dealing with drug-seeking patients. But those sources of information were spotty and incomplete up to a few years ago.
This is exactly right. My wife is a pharmacist and our state only recently implemented the database of medication history. In the past a seeker could go to any doctor, or any pharmacist and they would have no idea of this patients medical / prescription history. So even if they denied the patient their prescription, they would just go somewhere else. When WV tightened the restrictions and limits on suboxone seekers would just leave the state to get ahold of it.
> Patients could have legit pain, and then go to multiple doctors, without the others finding out. Then they could sell those to other people, or use them all themselves
I can't imagine many people that have real pain bad enough to need opioids are going to be selling them to other people.
For people that really need them to manage pain, they can literally be a live saver.
Opioids are worth lots on the street. Even people with "real pain" still need money right? Especially in a state like WV.
So if you can get enough pills to cover your own pain management (meaning you likely can't work anyway), and you know you can get and sell more pills by going to other doctors, why not?
I had a friend who was a pharmacist and worked at several places like CVS. He said they routinely refused to fulfill prescriptions to people they felt were either gaming the system or were using outright fraud to get their meds.
He said after a while it became a game. User would get a script and come in totally strung out. My buddy would refuse to refill their meds. User would call doctor and yell and them. Doctor would call Pharmacy and yell at my friend, who would then have to tell the Doctor what was going on. Most of the time, he said the Doctors had no idea this person had 15 different scripts for pain killers.
For me, there's still too many loopholes to exploit in the process.
I'm in favor of maximum MD power. I think they should be allowed to prescribe everything from cocaine to bleach, or any other chemical compound, as suits the patient care, if they know what they're doing.
But they should also bear maximum accountability for what they prescribe, including abuse potential.