Far too many health care providers are more concerned with patient satisfaction than they are with protecting patients from the risk of prescription drug abuse and addiction. This attitude is enforced by current teaching in pain management, which is largely based on a concern for providing relief for patients with chronic pain.
The National Institute on Drug Abuse estimates that roughly 116 million Americans suffer from chronic pain. Healthcare providers have long struggled with the challenges involved with the long-term treatment of pain, including the need for escalating doses as patients become tolerant to medication and the risk of addiction.
Doctors and Hospitals Worry about Negative Patient Feedback
According to Sherry Green, CEO of the National Alliance for Model State Drug Laws (NAMSDL), education for prescribers needs to focus less on patient satisfaction and more on improvements in patient functioning. Green also points out that with physician ratings available online, some doctors feel pressured to give patients the drugs they ask for rather than risk a negative rating. Hospitals are also contributing to the pressure to satisfy patients due to their own fear of negative patient feedback.
Green’s comments were made at a recent NAMSDL meeting that was convened to address the problem of “pill mills” and prescription drug abuse. Meeting attendees included law enforcement officials, addiction experts, doctors and medical board members.
Individualized Patient Care is the Key to Safe Use of Medication
The group identified the practices of so-called pill mills as a major contributor to the current prescription drug abuse epidemic. These practices include a focus on prescribing drugs without taking medical histories and a lack of physical examinations and follow up on patient outcomes. Patient care is not individualized – the same medications are provided to all patients regardless of their condition. In contrast, Green defines legitimate pain management as a holistic process that involves a variety of different approaches in addition to prescription drugs.
To minimize the risk of addiction, physicians should become familiar with each patient’s risk factors, including a family history of drug abuse or mental illness. It is also crucial to monitor patients for signs of abuse while they are taking prescription drugs. Frequent requests for refills and claims that a prescription has been lost are two of the warning signs of drug abuse.
A preliminary set of proposals that will help policymakers enact practical solutions for prescription drug abuse were drafted at the NAMSDL meeting and will be distributed to stakeholders for review. Many states are currently focusing on implementing prescription drug monitoring databases to fight the proliferation of pill mills. Getting doctors and other drug prescribers to consult a state database before writing a prescription for a patient who may be doctor shopping is one of the many challenges that these states will face.