07 Apr How Prescribing Practices Impact Drug Abuse
Insurance companies claim that one way to hold down health care costs is to have doctors not start patients out with the most expensive pain relievers. Start with less costly analgesics and work your way up from there, they say. This would have the added benefit of keeping excess pain relievers out of circulation, where they are often used recreationally and addiction risk is higher. But physicians say this is a prescription for unnecessary patient suffering.
New Jersey’s Prescription Monitoring Program (PMP) has been in the spotlight, with former Governor James E. McGreevey heading up a task force looking into heroin and opiate use in the Garden State. With a PMP all prescriptions are entered into an online database along with all sales at pharmacies. PMPs make it a simple matter for law enforcement to see whether or not prescribing habits are in line with particular specialties.
McGreevey is highly critical of doctors that aren’t using the PMP before prescribing patients with drugs they may already have access to. One option is to mandate doctor participation in the New Jersey PMP.
Taking part in the program is voluntary in New Jersey. Right now only 15 percent of doctors participate in the state’s PMP. If doctors checked online for a patient’s drug prescription history it could prevent the problem of doctor shopping, which refers to people visiting multiple doctors for the same complaint in hopes of being given several drug prescriptions. A quick look online would let doctors know if the patient in their office was guilty of the practice. It would also allow police officers and drug agents to see which doctors are handing out pain medications a little too freely.
While insurance companies want less expensive drugs as a starting point, doctors argue that the doctor-patient relationship is the best place for making decisions about which drugs should be used and when. By having patients try several rounds of painkillers before finding the appropriate-strength medication, doctors say this actually feeds the problem of prescription drug abuse as several bottles of partially-used pills would be lying around. Drugs in the house wind up being prescription drugs on the streets. It’s a lose-lose proposition, according to the doctors.
Patient advocacy groups are having their say as well. Lobbyists for the American Cancer Society say that pain is subjective, and it would not be in the best interest of patients to have bureaucrats deciding what pain medications they should be given. The idea of cancer patients spending days or weeks in avoidable pain is untenable to most people.
There is a long-standing tension between healthcare providers and the insurers who pay for the bulk of healthcare services. On the one hand doctors want to provide the maximum available pain control to their patients, and on the other insurance companies are looking for ways to control rising costs. New Jersey’s legislators will have to find a way to end the tug-of-war.
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