Chronic pain and how to treat it is a big topic in the medical world right now. In one study, 39% of patients coming to the emergency department with pain reported an underlying chronic pain syndrome. Prescription drug seekers can overlap with patients who have true acute pain and need relief. We want to provide pain relief, yet we know that many of these prescription drugs get diverted and used for non-medical conditions.
After marijuana, prescription drugs are the most commonly abused drugs of 12th graders. More than cocaine, meth or other drugs that we worry about, kids are getting into their parents' medicine cabinets. These prescriptions are getting into the wrong hands.
Doctors and pain clinic owners in three states were charged today with distributing prescription drugs in Kentucky, an area that is rampant with abuse. One doctor prescribed more than 125,000 Oxycodone pills from September 2006 until July 2011. And in Florida, several doctors were arrested this week for running a "pill mill" and pocketing millions of dollars.
Those are the egregious cases and jail is the best place for these physicians.
Most physicians, however, are caught in the difficult role of providing adequate pain relief for acute and chronic conditions and balancing that with the addictive potential of narcotic medications.
Most emergency department physicians (and nurses) and every primary care physician who has a few years of practice under his or her belt can spot a drug seeking patient. The tall tales are absurd and follow certain patterns:
"I lost my prescription." Variations on this theme are that the pills fell in the toilet, were eaten by the dog, hamster or (insert animal here).
"The pills disintegrated." The pills got wet, got mixed with noxious substance, the container opened and they got dirty.
"I'm allergic to other pain relievers." This one is usually the new patient who gives the history of trying everything you mention, but only Vicodin or Oxycontin or Demerol will work. Period.
"My prescription was stolen." Common tale. Lots of theft, it would seem.
"I have recurrent (insert condition here) and need the medication on hand." (kidney stones, bowel obstruction, migraine headache, back pain, menstrual pain, sickle cell anemia...)
"My pain is a 10 out of 10." All the time.
Chronic pain is truly debilitating and we doctors want to relieve pain and help patients get back to their normal lives. But we can be the problem as well as the solution. Each narcotic prescription we write has the potential to harm as well as help and we have to be conscious of our own prescriptions and how they are used. My wish would be for a strong pain reliever with no side effects that is not addictive. Problem solved!
This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.