How do we control opioid abuse without hurting chronic pain patients?


Efforts to curb growing rates of prescription painkiller abuse--along with healthcare fraud and wasteful spending riding on their coattails--have made it harder for patients with chronic pain to get the medicines they need.

There are 100 million of these patients nationwide, according to JD Supra Business Advisor. They use narcotic pain medication prescribed by doctors to cope with illnesses including cancer, rheumatoid arthritis and fibromyalgia.

"We don't sell [pain medications], we don't snort them, we don't steal them," a patient wrote in a support group blog post. "But ... we are made to pay the price [for] what the sleazy underworld has done."

New federal rules effective Monday moved prescription drugs containing hydrocodone into a stricter drug class reserved for dangerous, addictive substances, according to Valley News. This means prescriptions for hydrocodone-containing painkillers are limited to a 30-day supply with no refills, and that each prescription for these drugs must be handwritten by a doctor, the newspaper noted.

Pharmacists unwilling to fill these prescriptions may tell patients the drugs they need aren't in stock, the blog post noted.

Healthcare advocates say this rule change will burden patients who live in rural areas and nursing homes. It also could cause spikes in costly emergency room visits, the Valley News added, and patients who turn to over-the-counter drugs to self-medicate run the risk of liver damage from taking too much.

Some doctors are "spooked" by the change and refuse to prescribe narcotics, Health Magazine reported. Other doctors make patients to sign a contract requiring drug screening and prohibiting doctor shopping, JD Supra noted.

Another factor inhibiting opioid prescribing is the possibility of prosecution. JD Supra cites these examples: A New York doctor was arrested for allegedly prescribing oxycodone to fake patients. Two Georgia doctors were arrested for prescribing drugs for patients without a medical need for them. And a Florida doctor was busted for drug trafficking based on prescriptions he wrote for narcotics.

Overall, the effects of addiction control efforts on chronic pain patients show public health policy that may help control fraud and waste can have unintended negative consequences.

For more:
- view the JD Supra article
- see the autoimmune disease support group blog post
- read the Valley News article (subscription required)
- here's the Health Magazine article

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