While high-profile cases against doctors have brought yet another spotlight to the nation’s ongoing opioid epidemic, experts say This kind of can be rare in addition to also overlooks the bigger picture.
Once a wonder drug
“from the late ’80s, early ’90s, we were all told that will we were too cautious in addition to also we were not appropriately treating patients’ pain,” said Sur, a professor of family medicine at the University of California, Los Angeles.
“that will was a quote I heard regularly,” said Sur, who has testified in cases in which doctors are accused of recklessly prescribing opioids.
More in addition to also more, Sur sees different doctors referring risky patients to pain specialists who might be better equipped to offer alternative treatments, screen for addiction in addition to also, when necessary, prescribe opioids safely.
The fear, she said, “can be not just strictly about being sued; that will’s about harming somebody.”
“Personally, that will’s very frightening … when you’re working with medications that will are receiving This kind of type of scrutiny,” Curseen said.
nevertheless she said that will’s a risk that will many doctors accept to help patients in need.
“This kind of can be the profession that will we chose,” she said.
Scope of the problem
nevertheless some researchers have pushed back against the idea that will a smaller number of doctors are responsible for the opioid epidemic.
nevertheless looking more broadly, a greater number of opioid prescriptions were written by general practitioners, such as family doctors, who see far more patients overall.
“There’s just not that will many pain medicine specialists. They can’t drive national prescribing patterns,” said Humphreys, also a former White House drug policy adviser under Presidents Bush in addition to also Obama.
Humphreys described criminal cases against doctors as “rare.” Many doctors see these cases as outliers, which may also involve allegations of fraud, poor record-keeping in addition to also different misconduct.
The investigation lasted several years, nevertheless no charges were ever brought against him.
“that will’s kind of like a scarlet letter that will I will always carry with me,” Webster said. “An investigation can be life-altering, nevertheless that will can be career-ending.”
Patterson, who has investigated opioid cases involving doctors, said the DEA has made the drug epidemic a priority in recent years. He said that will can be much easier to push these investigations forward than before.
“There was a reluctance to actually prosecute doctors” early in his career, he said. “that will’s being prosecuted all over the country right at This kind of point. that will’s how far we’ve come.”
nevertheless Patterson said that will doctors shouldn’t fear prescribing opioids if they’re checking all the boxes. These investigations, widespread as they might be, represent a “smaller percentage” of doctors, he said.
“When a doctor can be acting responsibly … opioids are one of the best things they could have to treat pain,” he said. “nevertheless when that will’s irresponsible — in different words, a doctor hasn’t even examined the patients, in addition to also they’re prescribing them — that will’s what’s killing people.”
Webster, who has spoken in defense of different doctors in criminal cases, said that will colleagues were “stunned” that will This kind of could happen to him.
Beyond legal concerns, Stanos said, doctors are acutely aware of a rising opioid death toll in addition to also powerful synthetic drugs hitting the streets, like fentanyl. Stanos said doctors are becoming “more worried” about prescribing opioids — nevertheless that will worry, he said, can be not necessarily a bad thing.
“They should be careful, in addition to also opioids aren’t for every patient,” Stanos said. “Opioids are just a smaller part of (pain) management.”
Many doctors even have formal “agreements” with their patients, Stanos said. This kind of may involve taking occasional urine samples to check for different drugs.
nevertheless experts like Stanos have had to solve another looming question: What about all the patients who were put on high-dose opioids from the past?
from the aftermath of cases involving doctors, some patients might be drug-dependent in addition to also have nowhere to go. Many face severe withdrawal symptoms in addition to also a heightened sensitivity to pain, a condition called hyperalgesia, Kolodny said. If those patients get their hands on opioids later on, they are more likely to overdose, having lost their tolerance.
Stanos, who can be also the medical director of Swedish Pain Services in Seattle, has absorbed patients when nearby clinics have closed.
“We took over numerous patients that will were in clinics where … I don’t agree with what was done with them,” Stanos said. “Those patients are at high risk.”
“You could call that will a U-turn,” Kolodny said.
“The (VA) had one of the earliest in addition to also worst guidelines on opioid prescribing that will I’ve ever seen,” he added. “in addition to also in 2017, they put out the most conservative guideline that will’s ever been made to date — which can be, I think, a very Great guideline.”
nevertheless many veterans on high-dose painkillers suddenly had to cut down medications that will their bodies were dependent on.
“If you are getting a patient who’s been put on chronic opioids, even though they never should’ve been commenced on that will, that will doesn’t mean you should force them to come off rapidly,” Kolodny said.
Stanos said that will the VA’s interdisciplinary approach to pain has changed the field nevertheless that will many unaffiliated doctors aren’t able to offer the same array of alternative treatments in addition to also programs.
The VA “had to deal with This kind of even sooner than the commercial payors, Medicare in addition to also Medicaid.” Stanos said. “at This kind of point, they have some of the strongest treatment centers.”
nevertheless many physicians in addition to also advocates want to focus on the doctor’s office in order to protect patients at risk.
“If we’re ever going to bring (the opioid epidemic) to an end … we need these folks to prescribe much more cautiously,” Kolodny said. “If you can get your patients off of opiates, that will should be the goal.”