Prescribing Narcotics: A Doctor's Point of View
It has been about ten years since the United States Drug Enforcement Administration (DEA) launched what some feel is a targeted war on drugs, the battleground being your Doctor’s office. The DEA feels there has continued to be a diversion of prescription narcotics for use on “the street.” I am not sure this is what they had in mind for Main Street.
The focus on physicians is perhaps the least resistant path to the easier drug bust; after all, physicians are supposed to maintain records of prescriptions written, and document the reasoning behind and the plans for the continued use of a prescription drug. That drug dealer out on the street is a tougher collar.
Physicians have been put through the wringer of the American judicial system, on charges ranging from drug dealing to murder, charges rooted in the over-prescribing of narcotic medications. There is a certain irony here, as such woes have befallen physicians in parallel with the development of drugs that have allowed significant relief for those sufferers of chronic pain. For example, the development of opioids has certainly helped the millions with chronic pain, and according to some accounts, only led to addiction in less than one percent of patients.
Nevertheless, in the minds of many there has been a consequent attitude among physicians that can, depending on the day of the week, range from hesitant to paranoid, and which has in turn stifled the prescribing of pain medications in even those end-of-life cases where pain can become a cloud that hangs over every dwindling minute of the terminal patient.
A couple of years ago, the DEA agreed that perhaps it had gone too far in restricting physicians’ prescribing habits, and began to allow physicians to prescribe multiple narcotic prescriptions in a single office visit. But chronic pain patient advocates still feel that there is too much oversight by the DEA. Physicians are still being monitored, which is not surprising if one considers the sharp rise in the utilization of prescription narcotics over the past decade, combined with the occasional high-profile death associated with their use.
And so it follows that there is a perception in this country that prescription narcotics are a “bad” thing for the patient, regardless of the stage of life or the degree of suffering. The result is that there are many patients who are living with inadequately controlled pain, and dying with the same. Many patients become disillusioned with – or actually hostile toward – the physician who will not give additional refills on prescription narcotics for the chronic pain due to a chronic condition. The search for pain relief becomes a struggle that the patient sees as wholly unnecessary.
Hopefully, there will someday be a more pervasively positive change in the way prescription narcotics are viewed. There has been a little bit of movement in that direction on the part of some parties–the DEA included. Still, I continue to hear many complaints of how those who take prescription narcotics are treated as second class citizens.
Perhaps some day there will be effective new drugs that will allow narcotics or opioids to be an unnecessary relic from the dark ages of medical history. These drugs will ideally not have the potential for addiction, and therefore not carry the stigma that some attribute to those who must take prescription narcotics to achieve pain relief.
In the meantime, doctors should be left to be doctors. No one needs a war on drugs in the doctor’s waiting room.
Mark Borigini is a doctor primarily located in Bethesda, MD, with another office in Downey, CA. He has 29 years of experience. His specialties include Rheumatology and Internal Medicine. He wrote for HealthCentral as a health professional for Pain Management and Osteoporosis.