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The Doctor’s Dilemma Part Two: Possible Solutions to the Overprescribing of Pain Meds


It is easy to place blame on clinical providers for the opioid epidemic. Popular opinion, according to Physician’s Weekly, has turned against “pill mill” doctors, suggesting that there is a widespread tendency to overprescribe pain medications that have led to widespread opioid addiction. 

This article, the second in a two-part series, explores current and potential solutions to overprescribing, including PDMPs, greater doctor-patient communication regarding the risk of opioid dependence, more research into non-opioid pain reliever strategies, and proper diversion to addiction treatment when appropriate.

Solutions to Stave Off Addiction Treatment

Instead of placing blame on clinical providers, turning cultural attention toward strategies to curb the over-prescription of opioids while finding new ways to manage pain are mandatory. There simply is no more time to point fingers, but instead, the focus should be on effective collaboration to solve what has become an increasing crisis in the United States.

An article in Psychology Today suggests that physicians have embraced the notion of pain-free treatments. It is interesting to note that each patient’s experience with pain is subjective. When coupled with the physician’s own belief system that treatment should be pain-free, prescribing pain medication becomes more acceptable. The article pointed out: “In fact, it is rarely possible to completely eliminate pain; trying to do so often results in excessive administration of opioids.”

Too, physicians receive very little training on alternatives to opioids, or pain management in general. ERs are frequently tasked with prescribing in a fast-paced setting; in a fragmented hospital system, this can lead to patients receiving prescriptions when they (perhaps) should not. 

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Ironically, patient satisfaction surveys often measure how well pain was managed. Doctors and hospitals that score low on this metric can receive lower reimbursement rates from payers. 

What solutions should be considered to curb overprescribing of opioid pain medications? Here are a few to consider:

  • Prescription Drug Monitoring Programs (PDMPs) are electronic databases tracking controlled substances at the state level. The CDC reports that PDMPs are showing real promise in helping reduce overprescribing in clinical settings.
  • Greater doctor-patient communication regarding the risk of opioid dependence, particularly in ER settings where drug-seeking behavior frequently occurs. In the absence of PDMP data, clinicians must use patient history documentation to assess the potential for opioid addiction or medication abuse. Patients should also be advised of the potential risks of using opioid pain medications, including the potential for addiction.
  • More research into non-opioid pain relief strategies. Alternative shorter acting opioids, NSAIDs, or nerve blocks can potentially serve as alternatives to fentanyl or morphine. Alternative therapies need further research. For example, a Brookings article reported on successful outcomes when outpatient nurses provided patients with behaviorally driven pain management skills. 
  • Proper diversion to addiction treatment when appropriate. Improving the ties between addiction treatment providers and inpatient and outpatient clinical providers will only increase the efficacy of the system as a whole.

Finding a balance between opioid overprescribing and pain management could mean the difference between patient health and long-term addiction treatment. Clinicians at all points of the care delivery spectrum must continue to monitor their prescriptive decision-making of opioid medications for pain management. New strategies in pain management, along with PDMPs and better physician-patient communication, all hold promise at helping turn the tide of the American opioid epidemic.

Lastly, clinicians who identify patients who are in need of addiction treatment must have a way to provide their patients with that valuable resource. If you are a clinician looking for an accredited addiction treatment program for your patients, contact us to find out more about referring patients to our facilities.

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