Tag Archives: doctors

post-surgical painkiller addiction

Should Hospitals be Accountable for Post-Surgical Painkiller Addiction?

Patients checking into a hospital for surgery is a very common occurrence. After their procedure, they want and expect to be given enough pain medication to be kept comfortable while they recover.

Often, the pain medication given by the surgeon and other medical providers is an opioid. They are prescribed for severe pain and are considered effective at providing temporary relief. The problem is that a number of doctors are prescribing these powerful painkillers without understanding how quickly patients can develop a dependency and thus start to experience withdrawal symptoms. When patients ask about how to taper off the medication when they are recovered from their surgery, they are often not getting enough information or accurate instructions.

Post-Surgical Opioid Dependency

Some doctors and hospital administrators are now asking the question, If some patients are becoming addicted to opioids starting with a stay in a hospital for surgery or another procedure, should the hospital be held responsible? Is the addiction a medical error in the same category as an infection acquired in hospital?

At least three physician/executives with the Hospital Corporation of America have argued that the answer should be, “Yes.” Drs. Michael Schlosser, Ravi Chari and Jonathan Perlin have stated that since this type of addiction arises during a hospital stay and is a “high-cost and high-volume condition,” and that it can often be avoided by implementing and applying new guidelines for patient care.

The doctors say that although it would be difficult for hospitals to monitor all the patients being given opioid pain medications in the weeks and months after their release, hospitals should have a system in place to try. The issue of long-term opioid use as a hospital-acquired condition opens the door for standards of care to be put in place to help patients manage their pain and protect them from coming to future harm.

Holding Hospitals Responsible May Have Financial Impact

Compensation and bonus structures at many hospitals are tied to patient satisfaction surveys, and that has been cited as one reason for doctors to continue over-prescribing drugs in an effort to keep patients happier. Less painkillers initially may mean that more patients experience some additional discomfort, and even though they may be saving lives from potential addiction, the doctors could wind up getting lower reviews and thus less pay.

Majority of Surgical Patients Have Drugs Left Over

Studies have revealed that the majority of patients (between 67-92 percent) have painkillers left over after surgery. Approximately 10 percent of patients need what is described as “intense pain management,” but it is difficult for physicians to identify which patients need this level of pain relief.

There are no set guidelines for what types of opioids should be prescribed after surgery, the typical dose that should be prescribe or how long patients should take them. In 2016, the Centers for Disease Control (CDC) released prescribing guidelines for opioids for chronic pain patients, but they only addressed acute pain briefly.

A new study published in September found that the optimal time for opioid use after surgery is between four and nine days.

Arizona Governor Suggests Mandatory Addiction Training for Doctors

Mandatory Addiction Training for DoctorsGovernor Doug Ducey has sent a letter to the Arizona Medical Board and the Arizona Board of Osteopathic Examiners making a push to have all Arizona doctors complete a continuing education course in drug addiction. He referred to the letter in his State of the State speech.

The speech was delivered a few days after Cronkite News published the results of an investigation indicating that some doctors had been overprescribing opioid pain medications for years before being disciplined by their professional board. In some cases, they were allowed to practice without restrictions even after being disciplined on several occasions.

Few Doctors Disciplined for Overprescribing

Only a small number of doctors have been disciplined in the past 16 years for overprescribing opioid pain medications. Of the 19,000 doctors licensed to prescribe controlled substances, 250 have been disciplined.

Arizona currently has a training program in place for doctors on prescribing opioids and treating chronic pain. The state doesn’t require them to take continuing education courses in prescribing controlled substances, pain management or substance abuse disorders. Some states, including Florida, Kentucky, Massachusetts, Oklahoma, Vermont and West Virginia, require doctors to undergo continuing education training in best practice of controlled substances, but this is not mandatory in all states.

Continuing Education Required for Doctors in AZ

Arizona doctors must complete 40 hours of continuing medical education every two years before they can have their license renewed by the Arizona Medical Board or the Arizona Board of Osteopathic Examiners.

The doctors can choose which continuing education courses they will take. Unless they are practicing in a state where they are required to take training in substance abuse or prescribing controlled substances, it is up to the individual doctor to choose whether to take this training. Ducey wants the boards in Arizona to require doctors to require one of the 40 required hours to be in addiction or Substance Abuse and Mental Health Services administration-supported opioid prescribing.

The governor remarked in his speech that drug addiction was a “problem that knows no bounds.”

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Doctors Can Help Curb Adderall Abuse

prescription stimulantsWhen Adderall and other ADHD medications first hit the market, many people were encouraged that those suffering from the disorder would get the help they need. However, as time has passed it has become clear that drugs designed to help people maintain focus and overcome attention deficits have turned into drugs that are commonly abused.

High school and college students tend to abuse these drugs at higher rates than other groups, but some studies have shed light on the growing Adderall problem among professionals and stay-at-home moms, among other populations.

In 2009 a study showed that 5% of high school students in the United States admitted to abusing Adderall. This number jumped to 7% in 2013. And a recent review of studies found that at least 5% and as many as 35% of college students rely on prescription stimulants to get them through their workload. Many experts fear that this early reliance on chemicals only increases the chances that they will resort to further illicit drugs use.

The problem with Adderall, like most abused prescription drugs, is that the pills are very effective for their targeted uses. They allow someone who is suffering from ADHD to be more focused and alert on single tasks. Doctors cannot stop prescribing this medication altogether since it does help some people, but prescribing practices need to be improved to ensure that those who do seemingly benefit an still have access, while other people who misuse the drug aren’t able to obtain nearly as easily as they can now.

The prescription drug problem has put the spotlight on the medical profession, causing some doctors and administrators to shy away from readily prescribing anything that can be addictive. This has caused further problems. Similar situations have been found in other areas of medicine, especially pain management. One of the best ways to help this for doctors to recommend more treatments and therapies that aren’t pharmaceutically-based and that are often just as effective without the side effects or risk of being abused.

Doctors Issue New Guidelines for Treating Opioid Addiction

doctors studyingThe medical community is immersed in the prescription painkiller epidemic in two ways. On the front end, doctors are often the ones prescribing the drugs like Oxycontin, Percocet and Vicodin to patients. Medical professionals are essentially the gatekeepers of prescription painkillers and often have to decide if patients are in legitimate need of medication or if they are seeking the painkillers to feed their addictions.

Additionally, doctors are also charged with treating addicts who are seeking help for their substance abuse problems. Because of this two-fold interaction with the prescription painkiller problem, the American Society of Addiction Medicine (ASAM) gathered doctors from around the country to develop better policies for dealing with the painkiller epidemic.

The first problem that the group encountered was the insufficient training in addiction medicine for most doctors. While most physicians certainly understand the basic fundamentals of addiction, the nuances of treating this disease is considered a specialized form of medicine.

Doctors who are not familiar with addiction treatments often do not prescribe medication designed to help with drug withdrawals and detox, such as buprenorphine. While studies show that monitored use of drug replacement medications illicit better results in treatment, many doctors still consider this is replacing one dependency for another when used indefinitely. Suboxone is one of the most popular medications given to patients with a heroin or prescription painkiller addiction, ad currently only doctors who meet certain criteria are allowed to prescribe the medication.

Another problem that was discussed during the meeting was the lack of treatment facilities. Currently, state-run facilities oftentimes run at capacity, while private treatment centers are struggling to keep up with the demand. Doctors can contribute to the treatment problem by encouraging addicts to seek treatment, helping them locate appropriate treatment and staying up to date with the changing methods of treating addicts.

“We just don’t have enough specialty treatment facilities and expertise in this country to treat everyone. That’s why we need guidelines like this as part of a larger movement to help integrate treatment into general practice,” explained Christopher Jones from the Department of Health and Human Services.

These new guidelines are scheduled to be included in the new ASAM’s National Practice Guideline and will also be included in the CDC’s Guideline for Prescribing Opioids for Chronic Pain coming out in the near future.

Emergency Room Doctors Can Help Reduce Prescription Drug Problem

aceperER doctors are well aware that many people addicted to prescription drugs utilize the emergency department as a way to obtain narcotic painkillers. They often go into the hospital complaining of various aches and pains hoping that a doctor will write a prescription for drugs like oxycodone or hydrocodone. Generally, ER doctors see so many patients that drug seekers feel more comfortable trying to get prescriptions there, as they might slip through the cracks.

A study conducted by researchers and published in the Annals of Emergency Medicine, concluded that doctors are not only aware that they work in a drug-seeking environment, but that they are more cautious when prescribing medicine that has a high rate of addiction. In the past, patients in the emergency room could expect to receive prescriptions for narcotic painkillers that would last thirty days. However, now that the prescription drug abuse problem is so problematic, most ER doctors have reduced the number of days they prescribe these drugs for.

“Our data show that opioid [narcotic painkiller] prescribing in the Emergency Department is done with caution and aligned with short-term use goals,” explained Dr. Scott Weiner, the author of the study.

In general, most prescriptions that are written in the ER are only for three to five days. This allows that patient to get the care they need, but it requires them to follow up with their General Practitioner in order to receive any more medication. It has been found that those with legitimate physical and health issues reliably follow up with their doctor, while those that were drug-seeking do not bother.

The study also charted the most common reasons why prescription painkillers were prescribed in emergency rooms. The leading situations included stomach pain, back pain, severe fractures, sprains and tooth pains.

The fact that these doctors are more cautious when it comes to prescribing narcotic painkillers indicates that the healthcare field is more aware of the role they play in the prescription drug problem in the United States.

Flaws in Prescription Drug Monitoring System Being Overcome

pharmacySome healthcare providers feel there are flaws in the drug monitoring systems that enable drug abusers to continue to score multiple prescriptions from multiple doctors without regulation. Imperfections in the current methods are being addressed before states can expect to fully rely on these monitoring systems to deter prescription drug abuse. Major adjustments in the system should allow doctors and pharmacists to utilize the program in the way developers intended.

The first issue with the drug monitoring system is the privacy of the patients. When a patient goes to a doctor they are discussing private matters that, legally, are not to be shared with anyone who isn’t involved in the patient’s care. By entering the patient’s name into the database and recording what prescriptions were given out, many people are concerned that this violates the patient’s privacy. The monitoring program can be accessed by other doctors, pharmacists and law enforcement. In order to get around the privacy laws many states have the doctors go through several waivers and disclaimers, making the program less user-friendly.

Another problem that states are encountering is that not enough doctors are willing to use the program. For instance, in Montana only 24.4 percent of eligible health care providers are actually using the program. In order to get more doctors on board, many people feel that the monitoring system needs to address the privacy concerns and make the program more manageable.

Despite the difficulties with prescription drug monitoring, it does appear to be making a dent in the prescription drug problem. Last year a county in Montana reported that there were 42 cases of prescription drug abuse fraud, compared to only 13 cases this year. Many people are attributing this decline to the implementation of the drug monitoring program.

However, with record numbers of prescription drug overdose deaths around the country, more efforts to use these programs are necessary, as the life-saving potential should far out-weigh the inconvenience.