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The Doctor’s Dilemma Part One: Is It Overprescribing or Proper Pain Management?


STAT News calls it a “moral cage fight.” That is the dilemma doctors are facing when they recognize that opioids are a medical necessity for treating chronic pain, but they also understand that prescribing them can lead to a life-long battle for addiction treatment. It is a catch-22 causing real consternation in a medical community tasked with “first, do no harm.”

There is also growing popular sentiment that the opioid crisis is spurred by physicians who have systematically over-prescribed pain medications to patients. This article, the first in a two-part series, examines the issue from both sides. Are doctors to blame for the crisis? What moral dilemmas do doctors face when trying to help patients with pain management?

Pain Meds Now Can Lead to Addiction Treatment Later

Today, one in three Americans blames doctors for the opioid crisis, according to a STAT-Harvard study. Yet doctors are the ones facing patients with chronic painful conditions and having to make the tough choices about whether the patient is exhibiting drug-seeking behavior or telling the truth about a pain threshold that is off the charts. 

How can a physician, tasked with providing compassionate care, alleviate the stress of making these decisions? What doctor, when faced with a patient in pain, will turn away from this distress and ignore a plea for pain relief? These are just some of the dilemmas faced by clinical providers in treatment settings around the country every day.

Yet Psychology Today points out the obvious fact that doctors have played a contributing role in today’s epidemic. They liken the over-prescription of opioids to the same phenomenon with antibiotics, and they suggest that these dangerous prescribing habits stem from patient pressure to release the drugs.

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It should be noted that doctors, as humans, are vulnerable to peer pressure. Psychology Today suggests that their behaviors are “not always governed by evidence, best practice, or guidelines.” When you couple this pressure with the belief that patients should be pain-free, you create an environment that is conducive to opioid over prescription.

Shouldn’t the pharmaceutical companies and distributors of these medications hold some culpability for the current opioid epidemic? CBS’ 60 Minutes interviewed a former DEA agent that suggests that these companies are more to blame than doctors, first for assuring the public that these drugs were safe, and then continuing to distribute them well after the death toll started to rise. The manufacturers and distributors of these medications failed to act on their knowledge of suspicious orders for these drugs from shady drug stores and over-prescribing doctors. According to 60 Minutes, in 2008, McKesson was fined $132 million and Cardinal with a $34 million fine for continuing to ship to pharmacies and doctors that failed to follow CDC prescribing guidelines.

So who is really to blame for the opioid epidemic? Is it the pharmaceutical companies who came up with a cost-effective way to alleviate pain? Or is it the distributor that continued to pump these drugs into the market, even as people were dying from them? Could it be the doctors themselves, focused on treating patients with painful conditions? 

All addiction treatment starts with an acknowledgment of the problem. Instead of pointing fingers, the medical community must come together to recognize where we are and then create a roadmap to alleviate the problem before more people fall victim to opioids.

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