Do Doctors Know What They’re Doing in Prescribing Opioids?

Do Doctors Know What They’re Doing in Prescribing Opioids?

A poll is out that indicates that physicians who prescribe opioids aren’t sure they are doing a very good in managing patients they prescribe.

Only 25% of physicians who are certified to prescribe opioids believe they are “very confident” in their skills to manage patients using these drugs.

The poll was released by Boston University’s SCOPE of Pain program. SCOPE is an acronym for Safe and Competent Opioid Prescribing Education.

The majority of the physicians surveyed agree. More than 90 percent say being knowledgeable about opioid therapy is an important issue.

Many have also taken proactive steps to improve their opioid prescribing practices. Sixty-five percent have implemented systems to support the safe initiation, monitoring and discontinuing of chronic opioid therapy.

Of those that have not implemented such systems, more than 60 percent said it was not a priority given limited time,” said Daniel Alford, director of the SCOPE Program, “It’s troubling that so many physicians say implementing safe opioid prescribing systems is not a priority, even though this is an acute issue. We’ve created a situation where some physicians are comfortable not doing anything about it. That’s why education is so critical.”

Creating better awareness of online training opportunities is part of the solution. More than 46 percent of physicians who completed continuing education on safe opioid prescribing completed it online.

“Chronic pain is incredibly common,” said Daniel Alford, director of the Addiction Medicine Residency program at Boston University School of Medicine. “A third of our population has said, yes, they’ve had chronic pain.”

Alford, like many believes more training on the treatment of chronic pain and safe opioid prescribing and management should be covered in medical school. He told Forbes Magazine that patients generally don’t appreciate the risk.

“While they may understand that others may become addicted or overdose, they are in denial about how this risk may apply to themselves,” Alfred said to Forbes reporter C.J. Arlotta. “Many patients don’t appreciate that opioids have limited efficacy for chronic pain and may not be the best treatment for everyone that suffers from chronic pain.”

Chronic Pain affects over 100-million Americans. This week’s cover story on Time Magazine talks about the pain killer addiction “crisis” in this country. Here’s the National Pain Report story on that. It said that 9.4 million Americans take opioids for long-term pain and 2.1 million people are estimated to be addicted to the medication.

There were no reliable studies proving opioids worked safely against chronic pain, because it would be unethical to require pain patients in a control group to go months on end without medication. “It’s not practical for us to require people to go for a year on a placebo,” says Janet Woodcock, head of the FDA’s Center for Drug Evaluation and Research told Time.

Authored by: Ed Coghlan

There are 10 comments for this article
  1. Duncan at 7:55 am

    Without opioid treatment I would be in absolute agony constantly. I have visited several ‘pain management specialists’ who don’t listen to what intell them and try to cut my dosage down because they believe opioid therapy to be ineffective and ’cause more pain’. The funny thing is, my pain killers work exceptionally well, but I would rather find an alternative to opiates as I don’t like the thought that they are addictive, yet when I tell a.pain specialist that I want an alternative, all they hear is, “I want stronger opiates”. This isn’t the case at all, but for some reason that’s what they hear. What I would dearly love is to find a non opioid treatment that has fewer side effects and works just as well. Sadly, because in the UK the only other pain meds available as Gabapentin, Pregabalin and Amitripyline – none of which do anything to me other than cause me memory loss, acid reflux or kidney pain and extremely bad mood swings, I will be on opioid therapy for life. If only the pain specialists were trained properly and drug companies were interested in finding new drugs, pain sufferers lives could be very different. In the mean time I have to put up with being treated like a junkie every time I attend any medical appointment and list my meds, even though they work superbly and have enabled me to hold down a job and enjoy my family for the last 10 years.

  2. Kristy at 5:16 am

    I take very high exception to this article. Also, that survey is based on opinions. There are a number of doctors out there that know very well what they are doing when it comes to prescribing the different meds they do for their chronic pain patients. I don’t appreciate the assumptions that all doctors are like this just like not appreciating the assumptions made about chronic pain patients that cause them to be lumped together. That survey does not speak for every single doctor in this country.

  3. K. Oliver at 11:34 am

    I agree that doctors should have to go through continued training with opioid medicine. Yet in the same training I believe they need to have chronic pain diseases taught with it. I was on a strict regiment of medications that worked well together for my painful disease, for over 8 years and never was in need of changing. Then as soon as the government started cracking down on issues like this, my doctor retired because he felt that his hands were being tied on how he was able to prescribe the best treatment for his patients. That left me in a place that I never thought I would ever have to be in again. My quality of life since that happened has been worse than when I was first diagnosed. So there are plenty of control patients for there study just like me.

  4. Kathy Childers at 6:55 pm

    Does Daniel Alford suffer from severe chronic pain? I doubt it. We that do suffer do not become addicted or overdose on the pain medicine. We use it as prescribed so that we can function and have some quality of life. I’m so tired of people trying to make it harder for those who really need pain medicine to get it. Have you ever heard of Trigeminal Neuralgia? Did you know it is known as the worst pain known to mankind? Did you now it is nicknamed “The Suicide Disease” because most people are NOT being properly treated for it especially since the DEA is making it so hard for doctors to actually get us the medicine we need? I have never wished this disease on anyone, but I really do wish you could have it for just a week and then let’s discuss opioids “having limited efficiency for chronic pain”. Please stop trying to punish the people who really need pain medicine and lumping up all together with the addicts who are abusing pain medicine. My prescribing doctor is a neurologist. I certainly believe that he knows more about who really needs opioids than you do or the DEA does. I have signed a “pain contract” with my neurologist and he does random drug tests. He’s got it. He knows what he is doing. Most chronic pain patients know more about opioids than the general public. We are not in denial about how risks may apply to us. We also know what happens when we can’t get our legitimate prescriptions for opioids filled because the pharmacies are afraid to dispense them. PLEASE stop this and let our doctors handle our health care so that we can have at least some quality of life and not have to live 24/7 with pain you cannot even imagine.

  5. linda at 4:38 am

    I spent 20 years on that PLACEBO called “it’s all in your head”. Perhaps they should ask those of us who were finally given their lives back through proper medication to come forward with our extensive medical records? Our trails of misery, as we lost family, and friends through increased isolation? Our lives falling apart around us due to our inability to perform activities of daily living? We suffer for years in silence, behind closed doors–let us out, and take us seriously!

  6. Deb at 9:11 pm

    they say it is unethical to make a patient go for a year without pain management. i’ve been two years without anything for my pain and there isn’t a doctor out there that cares. welcome to my world.

  7. Juli L. at 7:23 pm

    I’ve been treated for severe chronic pain for 34 years.
    Until pain management doctors put me on full-time opiate managed care, I was in too much pain to hold down a full time job.
    I was on managed opiate care and was doing well up until 2013 (12 years on my full time job) when all the prescribing rules changed.
    The doctors blame drug addicts, the pharmacies blame the patients. It’s a giant mess.
    I know terminal cancer patients who are worse off than me but being treated as poorly.
    What is going to happen to millions of patients on opiate meds for chronic pain when they stop prescribing them all together?
    This is going to be a huge problem.
    In the meantime however I’m still suffering with under managed pain 24/7.
    It’s almost too much too bear. I don’t know how long I can push through the pain. Maybe till I pass out?
    Is this really what the government wants?
    Doctors being threatened their d e a licenses so patients care is not a priority.
    Something needs to change..and fast!

  8. Stephen M at 2:48 pm

    Drug tests and Pain contracts have never been shown to benefit Pain patients, just doctors and lawyers, so why should they spend valuable time implementing them?

    Everyone knows that opioids work, we just don’t Haber placebo controlled studies, but there are other kind of evidence. Forest Tennant published a small study of high dose chronic opioid therapy of patients who had been on COT for decades.

    Also, if it is unethical to give a pain patient a placebo for years, why isn’t it unethical to give a pain patient nothing for years?

  9. John S at 11:15 am

    They could start with patients that have been taking opioids for a long period of time.

    Just talk to us. Communication goes a long way.

    100 million chronic pain patients don’t need long term opioid treatment

    Thank you

    jjs

  10. Louis Ogden at 10:55 am

    Ms. Woodcock said: “There were no reliable studies proving opioids worked safely against chronic pain, because it would be unethical to require pain patients in a control group to go months on end without medication. “It’s not practical for us to require people to go for a year on a placebo,” says Janet Woodcock, head of the FDA’s Center for Drug Evaluation and Research told Time.”

    I am in agreement that a scientific study is nearly impossible given that a placebo would be cruel and unusual punishment; however, there are some people like myself with chronic intractable pain that have had excellent results with opioid therapy. I am 65 years old and have suffered pain all of my adult life and part of my childhood. I have been on opioid therapy now since 2010 and I am experiencing the highest quality of life I’ve ever had as an adult. I can do physical work now that I was not able to do most of my life. Opioids can be a very valuable tool for SOME people.