Blogs: The Reinvented Pharmacist

Have We Gone Too Far With Prescribing Narcotics for Pain Management?

Published Online: Tuesday, April 10, 2012
The New York Times (4/9/2012) reports, “The most aggressive effort is under way here in Washington, where lawmakers last year imposed new requirements on doctors to refer patients taking high dosages of opioids—which include hydrocodone, fentanyl, methadone and oxycodone, the active ingredient in OxyContin—for evaluation by a pain specialist if their underlying condition is not improving … even before the new provisions took effect, some doctors stopped treating pain patients, and more have followed suit.” The article adds, “Washington State officials acknowledge some of the law’s early deficiencies, including its sometimes indiscriminate application, and they are seeking to address them.”
 
In our efforts to promote good pain management, have we gone too far? This article seems to suggest that we have. Although not all medical professionals agree, the article suggests that more people are coming to that conclusion.
 
I’ve long observed that in health care our approach to care—or even public policy—is like a pendulum. When it swings too far we push it back. Is that what is happening with pain management today? I admit that this is not my area of expertise, but it’s hard not to think that the over-promotion of pain medicine, along with the desire to help with good pain management by prescribing narcotics, could have led to overuse of these drugs. The results are unnecessary deaths and perhaps even poor patient management. The article is based on the state of Washington’s law which requires doctors to refer patients on high doses of narcotics to a pain specialist. Apparently, other states are considering similar legislation.
 
Some pain experts are beginning to realize that long-term outcomes for patients treated with high doses of opioids are appalling. Although I would rather see us clean up our own mess than have the government mandate actions with laws, maybe that approach is necessary to get our attention. I think the pendulum has swung too far with the prescribing of narcotics. Changes are needed—and unless we make them voluntarily, the situation may require the government’s intervention. What do you think?
About
Fred Eckel, RPh, MS, Editor-in-Chief of Pharmacy Times
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This blog focuses on what our Editor-in-Chief sees as the future of pharmacy.
Author Bio
Fred Eckel, RPh, MS, is the Editor-in-Chief of Pharmacy Times, a position he has held since 2002. Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

In this blog, Eckel will provide commentary on relevant issues impacting pharmacists and pharmacy professionals, including the merging of pharmacy benefit managers, the implications of health care reform, the conversion of major drugs from prescription to over-the-counter, trends in pharmacy careers, and opioid abuse. He will also discuss legislative issues that impact pharmacists, and comment on the evolving role of the pharmacist.
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