AP is running an article today on a ninety percent increase in sales of major painkillers between 1997 and 2005. The article wavers between whether this is a good or bad thing. There are a number of factors which might cause this increase. More people are living longer and more are living longer with problems such as cancer. Another factor not discussed by the article is that attitudes have changed in the medical profession. Not long ago the prevailing attitude was that narcotics should generally be used short term and should be avoided for problems such as chronic back pain. Medical recommendations gradually changed to include more use of pain medications when more conservative measures fail with physicians adopting these recommendations. Attitudes on dependence have changed where it is no longer felt necessary to avoid dependence on narcotics at all costs if the narcotics can result in an improvement in the patient’s quality of life.
is running an article today on a ninety percent increase in sales of major painkillers between 1997 and 2005. The article wavers between whether this is a good or bad thing. There are a number of factors which might cause this increase. More people are living longer and more are living longer with problems such as cancer. Another factor not discussed by the article is that attitudes have changed in the medical profession. Not long ago the prevailing attitude was that narcotics should generally be used short term and should be avoided for problems such as chronic back pain. Medical recommendations gradually changed to include more use of pain medications when more conservative measures fail with physicians adopting these recommendations. Attitudes on dependence have changed where it is no longer felt necessary to avoid dependence on narcotics at all costs if the narcotics can result in an improvement in the patient’s quality of life.The down side of more prescription pain medications being available is that more can be diverted for illegal use. There are rare cases of doctors who open store fronts to sell prescriptions without actually practicing medicine. The problem is in weeding out the abuses from the cases where patients benefit. It is not always easy to determine when seeing a new patient if they are actually suffering from pain or if they are inventing stories to get drugs. There are no objective tests to measure pain and we are largely dependent upon what patients report. Some are clearly drug seeking, but other cases are not so clear cut. Tests such as MRI’s sometimes help, but people without significant pathology can have a normal MRI, and an MRI will not show all possible causes of chronic pain. It is unavoidable that if we are going to adequately treat those who are in pain a certain number of people will obtain pain medications under false pretenses.Doctors often make an easy target for the FDA, with the Bush administration increasing prosecution of physicians. However, the article notes, “it is far more common for people to illegally obtain prescription drugs from friends and family members.” It is traditional to counsel patients against sharing pain medications, and this is typically included in pain contracts which must be signed before receiving narcotics, but we cannot control what people do.
In some cases there is clearly illegal action when a doctor has a storefront to sell pain medications without examining patients or offering other treatment. In other cases prosecution is feared to be the result of overzealous government action. “The DEA cites 108 prosecutions of physicians during the past four years; 83 pleaded guilty or no contest, while 16 others were convicted by juries. Eight cases are pending, and one physician is being sought as a fugitive.” (I wonder if that fugitive will ever find the one-armed man.)
The increased number of prosecutions now has many physicians reluctant to prescribe pain medications, which causes problems for patients who require the medications:
Spooked by high-profile arrests and prosecutions by state and federal authorities, many pain management specialists now say they offer guidance and support to patients but will not write prescriptions, even for the sickest people. The increase in painkiller retail sales continues to rise, but only barely. There was a 150 percent increase in volume in 2001. Four years later, the year-to-year increase was barely 2 percent.
People who desperately need strong painkillers are forced to drive a long way — often to a different state — to find doctors willing to prescribe high doses of medicine. Siobhan Reynolds, the widow of a New Mexico patient who needed large amounts of painkillers for a connective tissue disorder, said she routinely drove her late husband to see an accommodating doctor in Oklahoma.
Other than for the more flagrant violators, going after physicians is yet another poor strategy in the failing war on drugs.
