Opioid Prescribing: Understanding the Risks

Opioid Prescribing: Understanding the Risks

The popularity of opioid analgesics for pain has plummeted as judged by healthcare providers on the front lines of prescribing. A large survey of primary care providers published in JAMA Internal Medicine found that many doctors are now reluctant to prescribe opioids for pain. They worry about addiction and side effects in their patients, yes, but they also fear prosecution and losing their licenses to prescribe.

Lynn Webster, MD

Lynn Webster, MD

Although some “adverse events” listed by the survey takers are actually expected clinical outcomes with opioids (i.e., tolerance, physical dependence), in a larger sense, the concerns expressed with opioids are well placed. Opioids are powerful agents that can be addictive or deadly in the wrong hands.

Results of the survey show huge majorities of the over 500 practicing U.S. internists, family physicians and general practitioners surveyed think opioid abuse is quite problematic in the community (90%) and that opioids are overprescribed (85%). This is true but only partially.

A closer look reveals a dichotomy: On the one hand, a glut of opioids, particularly for post-surgical and dental pain, results from over generous prescribing that happens when a patient receives a 30-day supply of opioids, a typical quantity, although the pain may be gone far sooner, leaving leftover medication now available to divert.

On the other hand, people are struggling to be treated. Numerous reports are surfacing that more regulatory actions targeting opioid prescribing have led to more cases in which legitimate patients with ongoing severe chronic pain conditions have been unable to fill their prescriptions.

An especially telling result from the survey is that nearly half (45%) of the respondents are less likely to prescribe opioids than they were a year ago. This accords well with the percentage (close to half) that moderately or strongly fear malpractice claims, prosecution or censure by a medical board.

High-profile prosecutions, such as that of Iowa pain physician Daniel Baldi, D.O., accused and eventually cleared of involuntary manslaughter and nine counts of criminal wrongdoing, have likely not gone unnoticed. Though testimony indicated the decedents died from a variety of causes, including deteriorating medical conditions, the use of medications not prescribed by Baldi and the abuse of illicit substances, no medical professional could be blamed for fearing the professional and medical devastation that would follow being targeted for prosecution.

Still, it is beneficial that physicians and other healthcare providers understand the significant risks involved in using opioids to treat pain, particularly long term, and in that regard, these results are welcome. I ask only that a follow-up survey be designed to answer this question: Are legitimate pain patients being denied a standard of care to which they are entitled because of fear in the medical community? Then we will get the complete picture of opioid-related harm.

There is a chasm of difference between appropriate concern and hysterical fear.

Dr. Lynn Webster is the past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs for PRA Health Sciences.

To learn more about Dr. Webster and his work, please visit http://www.lynnwebstermd.com/

 

 

Authored by: Lynn Webster, MD

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Ryan Lankford

What happened to Dr. Baldi is nothing short of a witch hunt, and it wreaked HAVOC on the chronic pain sufferers of Des Moines, IA. Even though Daniel Baldi was acquitted, he’s been financially ruined, and doctors and mid-levels are now scared to take care of chronic pain patients.

Idalia

My spine and joint doctor had prescribed Tramadol for me as I am allergic to hydrocodone. I would take it only as necessary and it lasted about a year and in that year I moved and have new doctor. I cant take them at night due to very vivid nightmares. I used the last 2 and my old prescription was good for 2 refills..well my old doctor says now I have to go see him if I want a prescription and my doctor here says I cant give them to you every month..so she wants 30 to last me forever I guess..she gave me that and made me go get an xray of my hip which she had from my old spine and joint doctor and up to when all this changed she would ask me if I needed Tramadol and I would say no cause I honestly didn’t need them just yet. After suffering with my arthritic hip and Fibro and a messed up spine along with RA for several weeks..I felt horrible that she would do that to cover her behind and nevermind that I have to keep getting x-rays so she can show DEA its all legit..Well now winter is here and I hurt and now what do I do if I run out of my Tramadol…I cant take Naproxen any longer so I am really upset with all of this..sorry this is so long but I am just your everyday person that happens to be in lots of pain to the point I had to retire after 29years of pain. I think they don’t understand it unless they have gone through all this themselves….

“They worry about addiction and side effects in their patients, yes, but they also fear prosecution and losing their licenses to prescribe.”
Close to half” fear lawsuits and prosecution (persecution) yet addiction rates are around 10% and this includes street addicts. Informally we patients figure our number is around .01%.

Thank you Dr. Webster for asking for the followup survey. Wanna bet the number of legit patients hurt by these stupid, fear mongering rules is around 90%! Is anyone reading the patient comments on this site? These surveyors should compile a list of subjects based off these comments and do a survey to see if the US medical system cares about the patients or their own ass!
(no offense doc.)

Mike

I fear the day my doctor or pharmacist refuses the opioids that I’ve had to take for chronic pain the last eight years. The politics and pharmacists wanting and making their own judgments on doctors prescriptions are growing to the point where after I moved the new pharmacist refuse to fill two prescriptions without talking to the doctor first. This was despite the fact that I was still at the same chain pharmacy where they could see my complete history of taking these drugs for years. my 18-year-old son had his wisdom teeth pulled, none of which were impacted, and he came home with a 30 day Percocet 10/325 three times a day which to me was a clear case of over prescribing for what would be a cute came for only A week at most. So points in the article are very well taken but doctors shouldn’t be cutting back on their prescriptions for fear of legal repercussions instead it should be because of better judgment.