We’ve talked a lot on this blog about regulating opiates, and the delicate balance between over- and under-prescribing of addictive medications. In general, I am fully in agreement with government efforts to step up controls on addictive drugs, and I think that physicians who are blatantly violating rules and common sense standards of prescribing should be appropriately punished. Unfortunately, as with every other decision, it is difficult to set absolute guidelines as to what is obviously wrong. A lot of inefficiency and moral grey area remains. In their efforts to crack down on our epidemic of opiate addiction, it appears that some federal agencies are on a witch hunt to scare physicians out of prescribing opioids, even in appropriate doses to appropriate patients. I have seen regulatory agencies become extremely aggressive in targeting physicians out of disproportionate fear of the addicts they might create.
One case that I am aware of made a few bad decisions in 2008 that involved giving prescriptions to some patients who he subsequently discovered to have addiction problems. This was not a physician who had been trained in addiction medicine, and the fervor regarding the prevalence of addictive disorders that we live with today was not present in 2008. This physician was certainly lied to by his patients, and he did inappropriately prescribe some opioid medications. Now, in 2012, four years later, the state board of physicians has gotten around to reprimanding him for his mistakes. In response to this reprimand he has decided to stop prescribing opioids to anybody, for any reason, at all. I don’t think that anybody would blame him for this decision. Nobody likes to have regulatory authorities scrutinizing them and threatening to shut down their livelihood, and this physician is certainly acting to preserve his practice and his ability to help his other patients. The state is presumably happy, as one more opioid prescriber is now “off the street”, but multiple patients who have legitimate need for opioid medications are now going to be “on the street”. With their physician out of the opioid business, they will have to either find someone else who is perhaps less responsible, or go off the medication and deal with the pain and sickness that implies, or — in the most extreme cases — try to get their opiate fix from an illegal source. As the opiate supply goes down, demand goes up, and people are willing to take more desperate measures.
As for the physician I know, his displaced patients will now add to the problem of those who need legitimately need opioids but cannot get them. The problem continues. We need to find a balance between appropriate supply and demand; the addiction epidemic is frightening, but a total ban on opiates, whether it’s intentional or not, is not an appropriate fix. We need a more nuanced policy than just a knee-jerk reaction to eliminate all supply of these medications to legitimate patients.