Overdosing on Painkillers

Adequate pain management is important, but in our zeal to do good, have we caused harm to too many patients?

The National Journal (11/2, Quinton, Subscription Publication) reports, “More Americans now die from overdosing on painkillers than from overdosing on heroin and cocaine combined, according to a Centers for Disease Control and Prevention report released on Tuesday.” CDC Director Dr. Thomas Frieden acknowledged that “deaths linked to opioid pain relievers such as OxyContin, Vicodin, and Opana have become an epidemic...adding that the rate of deaths has more than tripled in the past decade.”

This article caused me to take a step back. I know that the misuse of narcotics was a nationwide problem, but the fact that the epidemic was caused by legitimate drugs—and not illicit drugs—was what got my attention. It was not too many years ago that I participated in conferences and programs to make pain the fifth vital sign. These programs were designed to adequately assess the patient’s pain level so that accurate pain management would then be prescribed.

I thought then, and still think now, that adequate pain management is important, but this recently released US Report makes me wonder that in our zeal to do good, have we caused harm to too many? When I entered into practice there was a stigma to using narcotics. Both prescribers and patients feared the consequences of narcotic abuse. That attitude seems to have swung the other way now, and perhaps we want to use these drugs too quickly.

The report suggests that we need to both change prescribing habits and implement drug monitoring programs. Although drug monitoring programs are up and running in most states, often prescribers and dispensers don’t review them before prescribing or dispensing controlled substances. I am sure that one of the reasons for this is that it adds time to a busy office or pharmacy operation—and time seems to be one commodity we don’t have enough of these days.

My fear is that unless we voluntarily implement programs that helps curb this epidemic, patients with legitimate need for good pain management will pay a price because the mandatory programs that could be put in place will cause prescribers and dispensers to not even want to handle controlled substances. Do you think my concerns are well founded?