19 Mar Prescription Drug Addiction: Who’s to Blame? – Part 2
The national epidemic of prescription painkiller addiction is a complicated issue involving patients, doctors, black market drug pushers, pharmaceutical companies, health insurance companies and clinic and hospital administrators. Understanding the role each plays may help to dismantle the rising problem of addiction to opiates and other prescription pain medications.
As mentioned, doctors are under immense pressure to keep patient satisfaction scores as high as possible and this has become a large part of the issue. Patients, using the Internet or the ads on TV, shop their own prescriptions and medical care. After scouring WebMD and online health forums, they have their own diagnosis and treatment approach planned, including the pharmaceutical therapies they intend to request. Using traditional avenues for advertising, pharmaceutical companies seek to market directly to the patient, putting the consumer power in their hands. Patients have come to desire individualized medical care “their way” and they will shop until they find the doctor who will provide it.
This is problematic. Patients are often enticed by skillful marketing tactics with little attention given to the potential consequences of the drug. A lack of medical training means they may not understand other health concerns at play or why a drug may simply not be right for them and their condition. They request the drug or treatment and expect to have their request met. Or perhaps a patient is prescribed a painkiller following an injury or procedure for pain management, but when the prescription has run out, the pain, the patient finds, is still present. Would it be possible to renew the prescription?
And despite the quality of care, if a patient comes in asking for pain meds and the doctor, suspecting an addiction, denies the request, he or she is at risk of receiving a low patient satisfaction score. This can adversely affect standing within a clinic or hospital as well as job security and career advancement. This reliance on patient satisfaction surveys can motivate doctors to make decisions regarding patients and their schedule of pain meds that are against their personal ethics. The heavy focus on patient satisfaction does not allow doctors to appropriately recognize and reject “drug-seeking behavior.”
Many doctors may also not know how to recognize such behavior or how to identify signs of a developing addiction. These drugs and their effects are complicated—even for physicians. Classic addiction behavior is not obvious to all. And again, the lack of time to get to know a patient and his or her needs and habits means red flags can go unnoticed and uninvestigated.
HIPAA, a law designed to protect patient privacy, is another force working against a doctor’s good intentions. Because clinics and hospitals do not share patient records, the prescribing physician may not see that the same patient has requested prescription painkillers from other physicians in the area. He or she is also unable to alert other doctors that the patient is exhibiting drug-seeking behavior and should not receive a prescription. Doctors lack the freedom to help patients avoid addiction or to aid those already caught in addiction. In this case, HIPAA laws may prevent this exercise of medical ethics and the best care of the patient.
It is also time for a new approach to pain. Drugs can relieve pain, but the cost can be high. Working with the patient to manage pain, using drugs only as necessary, seems tedious and uncomfortable and time consuming. Certainly it is easier to just up the dose. And while drugs can be a useful component of a pain management program, they are only a part of it and should be seen and used as such.
When the prescription is written without questions, the patient gets what he or she came for, but these remedies are often ineffective in helping patients to genuinely eliminate pain. For that, alternative therapies must be tried and implemented. Drugs are the default, but may not be the most effective treatment approach and often diminish the motivation of doctors and patients alike to do the hard work of seeking healthier, less risky, more effective and long-lasting approaches to pain management. However, the risk in that approach is that the patients will give poor feedback because they felt their needs (or wants) were not met and may simply choose to seek their pain management therapy elsewhere.
There is no easy answer—the problem of the painkiller addiction epidemic is a tangled one. There is the reality of pain—physical and emotional, human need, ethics and economics. It is a web of competing and often conflicting interests between patients, doctors, pharmaceutical companies, lawmakers, health facility administrators and health insurance companies. Addressing the problem on a large scale will involve dealing with each of these facets.
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