Many Doctors Fail to Monitor Potential Opioid Abuse Appropriately


Some Factors Beyond Doctors' Control

Other addiction specialists say it can be very difficult for doctors to monitor patients for drug abuse.

"Doctors are not detectives or mind readers and they are relatively trusting of people," said Dr. Gregory Collins, section head of the Alcohol and Drug Recovery Center at the Cleveland Clinic. "Doctors have a hard time assessing whether complaints are valid and have to rely on self-report when it comes to pain."

Patients may also hide a lot of information from their doctors, such as psychiatric medications they may be on, said Dr. Robert E. Gwyther, a primary care physician and addiction specialist as well as a professor of medicine at the University of North Carolina at Chapel Hill School of Medicine. Mixing certain psychiatric medications with opioids can have dangerous effects.

"Do they know all the drugs people are taking? Hopefully, doctors will ask," said Gwyther. Patients aren't always forthcoming about overuse or about getting painkillers from other doctors. Gwyther also said that people often get painkillers from other people, and doctors have no way of knowing about it. He believes that primary care physicians are unfairly scapegoated.

For people who have a history of abuse, those medical records may be sealed, said Collins. Doctors also don't have the time to go through a patients' entire medical chart or talk to family members about whether there's been abuse.

"Getting that kind of information out is time-consuming and frustrating," he said.

Doctors often feel a lot of pressure to treat their patients' pain. That could also lead to the over-prescribing of painkillers.

"There's an expectation that doctors are going to relieve all their pain," said Gwyther. "Doctors need to work with people to find a level of pain relief they can function with."

Although the study found that many primary care physicians don't perform urine drug tests on people who are on long-term opioids, Collins said they're not always a feasible option.

"There's a stigma attached to those tests," he said. "Also, cheating is easy, and a lot of the opiates may not even show up."

Federal Regulation Under Consideration

Five U.S. senators have introduced the Prescription Drug Abuse Prevention and Treatment Act, which among other things would encourage physician and patient education and introduce a monitoring system for prescription drugs.

"The act will make it harder for doctors to prescribe them," said Ross. "They will need a certain number of hours of education, certain licensing and it will introduce some penalties."

Gwyther says this kind of regulation isn't necessary. The problem, he believes, is much more complicated because of the factors that doctors can't control.

Addiction experts and primary care physicians agree that prescription drug abuse is a growing public health crisis, but their ideas for the best ways to address the problem vary. Some say there's a need for strategies to identify patients at high risk for abuse, others say more doctor education is needed, and still others say standards of care should change to foster a better understanding between doctors and patients.

All disagreement aside, Whitney O'Neill said she's proof that despite the continually rising tide of prescription drug dependence, there is hope.

"It's a huge misperception that people don't recover. People do recover."

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