Doctors often gave no good reason for prescribing opioids, new study finds – by By Maggie Fox – Sept 2018
Doctors gave no good reason for prescribing opioids to patients close to a third of the time during the buildup to the opioid overdose epidemic, researchers reported Monday.
A close check of medical records from 2006 to 2015 showed that a physician gave no explanation at all for writing an opioid prescription in 29 percent of the cases, the team at Harvard Medical School and the Rand Corp. found.
That’s a huge problem for their hapless patients because it leaves these doctors vulnerable to be shut down by a DEA raid, cutting off all their patients without any means to continue their medical care.
These doctors are endangering themselves and their patients when every opioid prescription is so carefully scrutinized by law enforcement.
The findings help support criticism by the Centers for Disease Control and Prevention, the Food and Drug Administration and others that say inappropriate prescribing practices have helped drive the opioid crisis, in which 42,000 people died in 2016 alone.
Just what we need: doctors giving ammunition to the anti-opioid zealots.
For so many of us, this is exactly what happens. For all the doctors I saw, (and me too) opioids were the last resort and used sparingly because it’s the last fall-back for human pain.
There’s nothing “stronger” or more effective, so if we become too tolerant to them, there will be little rescue if we ever suffer a painful injury.
From a biological/medical view, there is no “maximum dose” of opioids because they are continually “used up” by the body to dampen pain. This means they can be safely titrated up to whatever is needed to control the pain.
I doubt that any of the folks making the opioid rules know this when even many medical providers don’t. Opioids have been demonized to the point that everyone is afraid to prescribe freely as needed.
Nicole Maestas, a professor of health care policy at Harvard, and her colleagues went through tens of thousands of medical records, focusing on more than 31,000 physician surveys that included a prescription for an opioid.
Two-thirds did include a pain diagnosis: usually back pain, arthritis, diabetes or other chronic condition. Five percent were for pain related to cancer.
Many patients had multiple ailments, so the researchers threw out any surveys that may have simply lacked space to record all the diagnoses. Still, many patients got renewals of opioids for no apparent good reason.
“At visits with no pain diagnosis recorded, the most common diagnoses were hypertension, hyperlipidemia (high cholesterol), opioid dependence and ‘other follow-up examination,’ ” the researchers wrote.
At the very least, doctors need to write down why they are giving someone an opioid, the researchers said.
How can this not be obvious to every doctor? While they know enough about the crisis to be scared away from prescribing opioids, why aren’t they scared enough to document their decision?
Even as a patient, I’ve learned to document anything I want my doctors to take seriously.
Who knows what they hear and how they interpret it when they write into our medical records what they believe we are telling them?
So I always do the documentation myself, carefully going back through my pain diary to include dates and numbers, both for levels of pain and the milligrams of opioids needed to control it. (unlike all those scientific studies that measure only the milligrams and not the pain)
I’m not sure why, but presenting a pain complaint verbally is just not taken as seriously (or trusted as much) as a written report. Perhaps it’s because we usually don’t mention specific dates and numbers while talking about pain, but these data are exactly what they need to justify our opioid doses.
I think doctors don’t bother asking about specific numbers because they know we can’t remember such details accurately unless we wrote them down at that time.
To get the best medical care, we have to step up and help our doctors because they are bogged down in the huge mess of our current healthcare system and don’t have enough resources to do their jobs correctly.
The 15 minutes they are allocated (by financial restraints) for our appointments aren’t nearly enough to
- do a thorough physical exam at each appointment
- take a history of the main complaint
- carefully listen to not just the words but to the meaning of what the patient is saying,
- discuss with the patient the various alternatives
- negotiate a treatment plan acceptable to both parties,
- write prescriptions, and
- then document the whole interaction.
Just looking at this list makes me wonder how in the heck they can do all that so quickly… and then seamlessly switch to the next patient and start all over again… for 32 appointments in an 8-hour working day.
Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing,” Dr. Tisamarie Sherry, who worked on the study, said in a statement.