I’ve written here a few times before about the responsibility that physicians bear in the spread of addiction, especially addiction to opiates and painkillers, which patients are often first exposed to for medical reasons. I’ve written about the dilemma that faces physicians who are dealing with a patient’s pain, and the need to balance relief of suffering with the possibility of future addiction. It is a complicated and ever-shifting balance, but it’s one that few physicians today are well-equipped to navigate.
A news article I saw this week details a recent spike in painkiller sale and prescriptions in certain parts of the country, including Appalachia and the Midwest. The article attributes the rise in oxycodone and hydrocodone use to “an aging population having more pain problems”, the increased willingness of doctors to prescribe these medications, and the “doctor-shopping” of addicted patients trying to secure a constant supply of opiates. In my post “Pain and Addiction“, I discussed how patients who begin pain treatment for legitimate pain can become addicted without even realizing it, and continue to pursue their addiction while under the impression that they are being treated for pain with a physical cause. The article linked above makes a point that there are only a tiny number of facilities able to medically treat addiction, while the availability of addictive substances is massive, and these substances are barely controlled, when they are controlled at all. The article points out one of the possible solutions, which I strongly favor and have been advocating for years: stronger computer systems built to handle and track medical records.
One of the major ways addicted patients can continue to feed their addiction is through “doctor-shopping”, or going to multiple doctors who will each prescribe pain pills, not knowing that the patient already has several prescriptions. Patients may be careful to choose doctors in different geographical areas or different specialties, or may be skilled at making sure doctors do not effectively communicate with each other. Especially at hospitals, in the ER, where the pace is frantic and there are constant emergencies to be dealt with, knowledgeable patients can manipulate the system to get massive amounts of these addictive substances.
This does not mean that these patients should be vilified; their drug-seeking a symptom of the disease. While patients must be held responsible for their actions, it is also the responsibility of the medical system as a whole to detect and prevent this form of abuse. Computerized medical records, and computer systems which allow all medical personnel to communicate with each other, are invaluable tools for detecting drug-seeking patterns among patients. Many older physicians have resisted the move towards computerized records, but only making the transformation complete will allow the system to accurately detect this kind of harmful behavior. The article linked above states that there is essentially no monitoring of addictive medications on a federal level, meaning that patients can often easily obtain more by going to a neighboring state. This is a terrible oversight on the part of the healthcare system, which requires regulatory oversight in order to ensure that it is helping the largest number of people while doing the least harm. Addiction and drug-seeking are essentially risky side effects of these pain medications, and by refusing to carefully monitor their prescription and use, we as physicians are rendering ourselves incapable of protecting our patients from these side effects. In many cases, patients are not even being informed of these side effects, so they may not know exactly what has happened to them, or that any help is available.
The current difficult economic conditions, which cause a great deal of unhappiness and uncertainty, have likely exacerbated the “epidemic” of substance abuse, leading to astonishing numbers like those reported in the article. But this is not a temporary problem. It is a systemic problem, with its roots deep in the way our healthcare system is structured. Until we can fix the underlying regulatory deficits, the problem of drug-seeking and other fraudulent, addictive behaviors will continue, and any improvement will be temporary.