Impact Government Efforts to Reduce Prescription Drug Abuse May Have on Chronic Pain Patients
Yesterday I told you about the Obama Administration's new program aimed at reducing prescription drug abuse and the FDA's new opioid Risk Evaluation and Mitigation Strategies. You can read that announcement here: White House and FDA Announce Plans to Reduce Prescription Drug Abuse
While I'm all for reducing the abuse of prescription drugs, I am concerned about how some aspects of the government's new actions may affect chronic pain patients. The bulk of my concerns fall into two areas:
1. The effect increased enforcement efforts will have on doctors' prescribing practices.
2. Further intrusion into patients' private medical records.
Too many doctors are already afraid to prescribe opioid pain relievers to patients who genuinely need them for fear of the Drug Enforcement Agency (DEA), which is looking over their shoulders. Some will only prescribe the mildest opioids for short-term needs, but will not treat long-term chronic pain patients. Others refuse to prescribe any opioids at all for any reason.
What kind of a chilling effect will increased enforcement efforts have on the remaining doctors? An example given in the Administration's Action Plan may give us a clue. In discussing the benefits of prescription drug monitoring programs (PDMPs) already in use in several states, the plan states, “One additional study has examined the effect of a trial of using PDMP data in an emergency department. It found that PDMP data changed clinical management in 41 percent of cases. Of these 61 percent received fewer or no opioid pain medications than had been originally planned by the physician prior to reviewing the PDMP data, and 39 percent received more opioid medication than previously planned because the physician was able to confirm the patient didn't have a recent history of opioid use.” This implies that chronic pain patients, who have to take opioids on a regular basis, would not be given opioids in an emergency situation because they have a recent history of opioid use.
While the plan gives lip service to making sure chronic pain patients receive the medications they need, I see nothing in the plan to ensure that would actually happen. Rather I fear we will be under even more suspicion than we are now and it will become even more difficult to get the treatment we need.
Private Medical Records
Ever since the government first began talking about requiring all patient medical information to be electronically recorded, I have been concerned about privacy issues. There have been more than 260 million data breaches in the U.S. in the last five years and 12% of those have involved medical organizations.
I can personally vouch for how easy it is for personal data to be hacked. My bank has had to issue me a new debit card twice in less than two years – the first time because the database had been compromised and the second because there had been fraudulent attempts on my account. I have no reason to believe my health records will be any safer.
But I digress. What concerns me about privacy in this new plan is the intention to develop a new law regulating pain clinics that would establish “a procedure to allow patient records to be reviewed during regular state inspections.” Under HIPPA regulations, another doctor can't even see my records without my permission, but a government inspector is going to have free reign?
The Positive Side – Education
On a more positive note, this plan does encourage increased education for prescribing physicians, pharmacists and patients. It is my personal opinion that effective strategies for educating all involved is the most effective means of curbing prescription drug abuse.
According to the statistics given in the plan, a 2009 survey “found that over 70 percent of people who abused prescription pain relievers got them from friends or relatives...” It's clear from the letters I receive and the questions I'm asked that a lot of people are not even aware that it is illegal to share a prescription medication with someone else. And many others don't know how to properly store, dispose of and protect their medications from theft. Perhaps some very pointed public service ads could help educate the public and reduce abuse without depriving choronic pain patients access to the treatment they need.
Those are just a few of my thoughts on the new plan. I'd like to know what you think. Please click on “Comments” below and share your thoughts and ideas.