How should opioids be prescribed?

According to the U.S. Department of Health and Human Services (HHS), the U.S. in the midst of a major public health crisis regarding the misuse of opioid medications.|

Today, more people die of overdoses related to the use of opioids than any other drug or medication. In fact, opioid deaths (including the use of heroin) have quadrupled since 1999. Approximately 650,000 prescriptions are written for opioid medications every day in the U.S. During the same day, about 78 die from overdose related to opioids.

However, the ones that perhaps suffer the most are those patients who truly have pain. Many doctors are now reluctant to prescribe these medications. And there are new laws being passed in order to stem the rising epidemic. Patients who need these medications for their medical problems are often made to feel like they are drug addicts and get denied these medications. For healthcare providers, it is often not easy to differentiate patients who may be in fact suffering chronic pain or those seeking these prescriptions illicitly.

How should opioids be prescribed?

Check state prescription databases. Most states now have online sites for healthcare providers to view prescriptions for controlled substances for a given patient. While this has been a great aid, deficiencies still exist. For instance, these records often do not cross state lines although patients do.
Review records. It may be clear in some cases that a patient has an issue with abusing opioids. Also, we should make sure a patient has a condition that legitimately requires the use of opioids.
Limit the number of pills. It is very easy for medications to fall into the wrong hands when there are too many lying around. That is why limits prescriptions to these drugs to a month supply only.
Have the patients sign a pain contract. In this contract, the patient agrees to receiving prescriptions for these medications from only one physician and from only one pharmacy.
Perform random drug screens. These are done to verify the patient is taking the prescribed medication. Opioids have a high street value and subject to diversion. Also, the risk of overdose is higher if a patient is abusing other drugs.
Do not prescribe other medications concomitantly that are known to increase overdose risk, such as benzodiazepines.
Have frequent follow-ups with the patient.
Refer to specialists, such as pain management doctors, to explore other options.

Unfortuantely, opioid abuse occurs in all races and socioeconomic levels. There is really no way to predict who may fall victim to opioid addiction. Also, it affects patients of all ages. In many areas, opioids are observed to be a gateway to IV heroin use, and we are seeing a resurgence of this drug. It is affecting teenagers as well.

People point the blame in many directions. Some blame big pharmaceutical companies who misrepresented the addiction potential. Others point the blame at doctors for prescribing these medications. Still, others blame a weakness in individuals for falling victim to this addiction.

The fact is this is a societal problem, and we are all to blame. We need to do a better job on controlling these controlled substances before the overdose numbers flourish further. We all play a role in ending the abuse, and it will never be resolved until we all step into that role.

Linda Girgis is a family physician who blogs at Dr. Linda.

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