Physicians writing on KevinMD about the drugs they prescribe and the ones they cannot get: prior authorization and step therapy, opioid prescribing and the tapers that followed the CDC guideline, the GLP-1 drugs from Ozempic to oral Wegovy and what happens when patients stop them, shortages, compounded versions, and what a prescription costs the patient. Three maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words, Prior authorization: what physicians say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.
In order to fully understand the issues surrounding opioid prescribing practices, it is important to review a brief history of how these drugs came to market.
Opium was the first opioid, derived from the sap of opium poppies whose growth and cultivation dates back to 3,400 BC. In the 18th century, physicians in the U.S. used opium for multiple ailments. Towards the end of the 18th century, the addictive qualities of …
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Why do we keep prescribing heroin for our patients?
Most of us do not know the basics of economics, although we should. It impacts every one of us every day that we are alive. Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize. I can’t explain fiscal or monetary policy. While I regard economics as a science, it seems that experts routinely interpret data differently, …
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The cost of drugs confounds this gastroenterologist
I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause.
To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information.
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Improving drug adherence will take more than money and technology
Nothing seemed to help the patient — and hospice staff didn’t know why.
They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.
The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high …
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Dying at home: The problem hospices have with stolen opioids
What is it like living in pain? Those of us who have ever experienced unremitting pain for months or years know that it is enveloping and all consuming. I struggled with intractable pain for several difficult years, and I am fortunate because my pain finally got better — what if your pain never did?
That is a horrible reality millions of people are living in right now. The chronic pain population …
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Want to stop the opioid epidemic? Stop prescribing opioids.
Good pain physicians are dying. Recently, Dr. Todd Graham was shot dead in a parking lot over refusing to prescribe opioids to a man’s wife. Physicians who care deeply and try to do the right thing are being murdered for not prescribing opioids.
I prescribe very few opioids in my chronic pain practice. I do so in a judicious and safe manner for my patients. I have excellent training, and I …
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Physicians are being murdered for not prescribing opioids
The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use.
There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them …
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Should only infectious disease specialists be allowed to prescribe antibiotics?
None of us wants to live in a world without access to lifesaving antibiotics. No patient should be subject to an allergic reaction or organ dysfunction from these drugs. No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out healthy gut bacteria.
Yet, every day, patients are prescribed antibiotics that they did …
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Explore the behavioral factors behind antibiotic misuse
Physicians are influenced by marketing. That’s no surprise. So are most consumers, as evidenced by television and radio commercials, billboards, pop up ads and targeted ads for drugs on your computer screen. Big Pharma markets not only to physicians, but also directly to consumers.
In a recent Washington Post op-ed, Dr. Nicole Van Gronigen made the case that Big Pharma successfully influences physician prescribing behavior via marketing. Specifically, drug …
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Are pharma gifts to doctors a red herring?
Recently in Missouri, a bill was proposed that would ban women on oral contraceptives (OCP) from working. In the world of politics, the use of contraceptives has been discussed ad nauseam, often without medical consideration. As physicians, in order to continue to uphold our Hippocratic Oath: “First do no harm,” it is imperative that we continue to challenge any law that goes against scientific evidence, and our voices must be …
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The oral contraceptive’s PR problem
It may seem strange that a gastroenterologist like me does not prescribe pain medicines.
Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.
I …
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Why this physician doesn’t prescribe pain medications
There was her 28-year-old daughter lifeless in an ICU bed.
Her name was Tricia, and she had dabbled with drugs since she was 15. As a child, she was artistic, adventurous, and always found excitement with other kids who tended to do risky things. She’d justify their behavior and say they were more fun and had better personalities.
Eventually, her mom and dad moved to a small town thinking it would be …
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One and done: a heroin and fentanyl cocktail
The New York Times says nonadherence to prescribed medications is “an out-of-control epidemic” in the U.S. and quotes a review in Annals of Internal Medicine, which found “20-30% of medication prescriptions are never filled, and approximately 50% of medications for chronic illness are not taken as prescribed.”
For example, “a third of kidney transplant patients don’t take their anti-rejection medications, 41% of heart attack patients don’t take …
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Don’t blame doctors for medication nonadherence
It is surprisingly easy to sell snake oil. I know, because I’ve done it. In 2014, I helped create and sell The Right Detox. This was a bogus detoxification program that purported to improve anyone’s well-being and perhaps, cure disease. I was the face of the scam. I launched The Right Detox at a spring-time women’s health expo in Tucson, Arizona.
I kicked off my sales-pitch in front of a small …
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Behind the scenes of a detox scam
This April, my turn to take the medical board exam rolled back around, necessary every ten years for maintenance of certification. I studied diligently for the better part of three months preceding the test (and I think I did well). It was actually pleasurable to go back over details that I had forgotten and to catch up on newer developments in the field. I realized that I don’t do nearly …
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Pre-authorization is hell. Here’s why.
A 10-year analysis of medical malpractice cases indicates that medication errors continue to represent a significant risk to patients and health care providers, despite myriad efforts to eliminate that risk. For events that occurred beginning in 2003 (12 percent) to those from 2012 (12 percent) the proportion of cases alleging a medication error was, essentially, unchanged. Raised awareness, advances in technology, and millions of dollars directed at improving the medication …
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Medication errors haven’t gone away
