Painkillers: Legitimate Use, Illegitimate Use, and Striking A Balance Allowing the Former While Preventing the Latter – Letter-Writer Expresses Frustration With “War” on Opioids, and I Respond
By Ken K. Gourdin
The Salt Lake Tribune recently published a letter to the editor about the difficulty Eric Browning’s wife faces attempting to manage her chronic pain, given efforts to prevent abuse by controlling access to powerful, highly-addictive pain medications. Often, physicians are in a tough spot, because if people kill themselves by overdosing on pain medication (whether purposefully or accidentally), many want to blame them for that, while, conversely, if someone is in a situation in which she needs such medication yet the precautions intended to prevent overdoses impede her access to it, many blame physicians (or in the case of Mr. Browning, pharmacists) for that, as well.
I sympathize with those whose access to needed medications may be impeded by physicians attempts—as well as those of other healthcare providers—to “cover their own posteriors” rather than meeting the needs of their patients. I said so in a comment about a story published in the Tribune regarding a physician who then was under investigation for his pain management practices a few years ago. For my comment, see here (I would post a link to the story, but I can’t find it for some reason. I will edit this post if I find the link to the story, this and all other links last accessed May 16, 2017):
For Mr. Browning’s letter (the letter to which I responded, including brief quotations from the letter itself in quotation marks in my response) see here: http://www.sltrib.com/opinion/5267329-155/letter-diagnosis-is-none-of-the.
In on-line comments to the letter, I responded to its writer directly as follows:
From your letter: “I am sick and tired of the media and these fake wars on drugs that some people legitimately need . . .”
You hit the nail on the head right there. As you yourself acknowledge, only some subset of the people who get these drugs legitimately need them. Certain opioids are a cheaper, perfectly adequate substitute for harder, more expensive, even more addictive street drugs, which is why they are so popular among those who do not use them for pain.
From your letter: “So, do I sue all her doctors for malpractice?”
Unfortunately, that’s a non-starter, unless one or more of the doctors in question failed to adhere to the applicable standard of care and, by so doing, directly caused injury which has resulted in the pain from which your wife suffers.
From your letter: “The answer is the entire pharmacy system is riddled with incompetence because certain pharmacies are now demanding diagnostic codes. These pharmacists think that they are going to second guess real doctors and specialists that have had 12 plus years of schooling and thousands of hours with millions of people?”
I’m afraid I don’t follow: Why is it incompetence for pharmacies to note why a prescription is filled using a diagnostic code? Arguably, that’s a perfectly sensible precaution. You may think it is an unnecessary and unduly burdensome step in getting a prescription filled, and you may be right about that, but that’s a whole different argument than saying that pharmacies, pharmacists, technicians, and so on, are incompetent simply because they opt to take that additional step.
And while qualifying to practice medicine is a more involved process than becoming a licensed, doctoral-level pharmacist because residency lasting an additional three to four years often is required to practice medicine, it takes at least eight years—four years of undergraduate study and another four years of doctoral-level study, not to mention passing the required licensing exam—to become a licensed pharmacist. [Some pharmacy programs combine undergraduate and graduate study, allowing their graduates to earn the Pharm.D. in six or seven years.]
And there’s much more involved in treating patients than simply prescribing medicine. (Indeed, that’s why becoming a physician is a more involved, more time-intensive process than becoming a pharmacist is.) However, that’s also a double-edged sword: Because physicians must keep more “balls in the air” than simply keeping track of what medications their patients are taking and how those medications may interact, they may not keep themselves fully abreast of the latest data regarding medication effectiveness, side effects, potential negative interactions between medications, and so on. By contrast, since filling prescriptions is [virtually] all pharmacists do, they are much more able to keep track of that new information.
I had an experience once that illustrates the potential difference in pharmacological expertise between pharmacists and physicians. I once asked a doctor who for many years has treated a chronic condition I have whether a certain class of medication might be effective in alleviating some of my symptoms. He said that using a medication from that particular class of drugs sounded like a reasonable idea, but admitted that his pharmacological skills had deteriorated (he’s a surgeon) such that he would need to refer me to someone else for evaluation and to prescribe anything.
I’m sorry your wife is having such difficulty getting the medication she needs. The line between preventing abuse of medications, on the one hand, while ensuring that those who need them get them, on the other hand, is a hard one to draw sometimes. Here’s hoping that accounts such as yours facilitate a dialogue which results in effective solutions. I wish you and your wife well.