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Primary Care Doctors Grapple With Treating Pain as Prescription Drug Abuse Grows

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Some pain experts say doctors not adequately educated about opioids are contributing to the problem of prescription drug abuse by overprescribing the drugs. Because there are relatively few pain specialists in the United States, pain management often is the responsibility of primary care doctors, according to American Medical News.

“Doctors have caused an epidemic, not out of malicious intent but out of a desire to treat pain compassionately,” Andrew Kolodny, MD, President of Physicians for Responsible Opioid Prescribing, told the publication. “We overprescribed and created a public health crisis.”

The number of Americans who died from overdoses of prescription painkillers more than tripled in the past decade, according to the Centers for Disease Control and Prevention (CDC). More people now die from painkillers than from heroin and cocaine combined. An estimated 14,800 people died in the United States from painkiller overdoses in 2008, a more than threefold jump from the 4,000 deaths recorded in 1999, the CDC said in a new report.

Family physician S. Hughes Melton, MD, who practices in Lebanon, Virginia, is seeing more healthy people in their 20s and 30s who are asking for painkillers. He conducts a thorough exam of everyone who asks for pain medication, including an X-ray to look for the source of pain. He examines their medical and prescription drug records, and requires a urine drug test. He does not prescribe pain medicine while he is waiting for the test results.

Steven Crawford, MD, a family physician in Oklahoma City, says it is often hard to verify patients’ complaints of pain. He points out headaches, back pain and limb pain cannot always be seen through a physical exam or imaging. He also says it can be difficult to determine whether pain can be managed with a non-opioid medication. Doctors do not want to leave patients who are in pain to suffer without adequate treatment, he adds.

8 Responses to this article

  1. Angel / November 23, 2011 at 1:18 pm

    After decades of generalized suboptimal pain management in medical settings, a more balanced approach had finally started to sink in. The fifth vital sign was instituted in ERs so that pain was not ignored as was frequently the case. It became a quality of care issue. However, medical education on pain care has remained scarce. If we want physicians and medical teams to have appropriate skills in this area, they should receive adequate training. The solution is not to go back to suboptimal treatment, instead we should enhance the pain management skills of PC teams. I understand this is being undertaken by SAMHSA, but maybe it could increase its pace a bit.

  2. Avatar of charlie
    charlie / November 20, 2011 at 2:29 pm

    Bull! My last doctor left me in serious Pain, enough to make me self medicte, I still cant find a doctor willing to help me and I am a 100% service connected disabled veteran! Thank god, I can atleast lie and say Im addicted and they will treat me with methadone, which has worse side effects than the opiods I was on for over 7 yrs and should still be on and not have to suffer all the time. I say it needs to be mannaged better from abuse potential, but it also prevents people like me, who have serious chronic pain from even getting the meds I need! what is up whit that?

  3. Carlos / November 18, 2011 at 2:28 pm

    I like to suggest that this is the problem when for some many years treating pain with opiates was such taboo, and the DEA kept tring to tell doctors how to prescribe medications. One takes the skills away from the doctors they will loose the skills. Fortunatly enought we are working with more and more effective pain treeamtntss slike Buprenorphine that are a effective and they dependency is much lower. Hopefully one day we develope and opiates that will not create physical dependence but provide effective pain relief.

    b

  4. PWKaplan / November 14, 2011 at 5:17 pm

    Less than 5 people dying out of 100,000 in the population per year is not an epidemic when you consider that most of the “overdoses” are people who were aged or quite sick and taking heavy medications to deal with cancer or other pain. You need to stop trying to manufacture a drug crisis that does nothing except make it impossible for people with real and legitimate pain to get adequate pain control. Those of you who lost the war on drugs have finally fastened on an issue that you think you can make headway on. Do doctors need to be educated? Sure. But facts don’t merit the daily hysterics of this website. The real problem and the REAL scandal is that treatment on demand is not available for the handful of Rx addicts who need it. Why isn’t this website running articles about the waiting times for addicts to get into detox or long-term treatment? Why aren’t you complaining about the states that make addicts, at the most vulnerable moment in their lives, sign a contract to pay for treatment whether they complete it or not? Why don’t you write about the funded, but ridiculously ineffective drug programs whose five-year follow-up rates are worse than natural attrition in terms sobriety? No, better we should go out and arrest a few doctors that legitimately try to help their patients

  5. Avatar of Hilary Smith
    Hilary Smith / November 14, 2011 at 1:36 pm

    FINALLY!! It’s time for the doctor’s of this country to realize that in regards to addiction, they are doing more harm than good. ER doctors in particular are noctorious for handing out addictive prescription medications to whomever they see.

  6. Carlos / November 18, 2011 at 2:38 pm

    When are they going to start requiring treatment staff to start taking the required science so that they can stop making rubbish up and call it treatment assessment or their Professional Opinion without any bases on evidence.

  7. Barry Lessin / November 18, 2011 at 10:18 pm

    As an addiction psychologist working with teens and young adults for the past 30 years, I can attest that the number of overdose deaths in my community in SE Pennsylvania has increased more in the past 10 years than in the 20 prior years combined. I agree with you that hysterics aren’t warranted for the reasons you mentioned but it sure feels like an epidemic to me.
    The prohibition-based war on drugs, with the US spending $50 billion a year on criminalizing addiction, basically attempting to incarcerate away a medical problem, is really a war on people. The people with the least amount of resources are the losers in this battle. Addiction is an epidemic that needs public health policies based on science, compassion, and human rights.
    And I also agree with you that traditional rehab programs are failing; Harm reduction treatment approaches, based on sound public health principles and evidence-based models of treatment, focus on reducing drug and alcohol-related harm without requiring a person abstain from all use in order to get help.

  8. Ben House / December 10, 2011 at 10:37 pm

    Right on Angel. I was most appalled by the dichotomy for the doctor. What medication beyond opiates? What about non-medication based treatment! I felt for the doctor’s sense of hopelessness because the training Angel speaks of is not being pushed as hard as the drug reps push for their product. I was once asked why counselors do not get more referrals by doctors and replied it was because we do not lobby as hard as the drug reps. I am sure the physical therapists and a lot more would line up on this point.

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