A Doctor's Take on Painkiller Abuse

Oct. 25, 2012— -- Some doctors knowingly prescribe powerful painkillers to patients who abuse them, according to a new editorial in the New England Journal of Medicine.

And as upsetting as it is, I'm one of those doctors.

As a resident physician in radiation oncology, I prescribe narcotics daily. All my patients have cancer. And with cancer comes cancer treatments, some of the most painful procedures medicine has to offer.

One of my patients, a young woman, had lingering pain from surgery, chemo and radiation. Both the attending physician and I were very sympathetic, and continued to prescribe daily Percocet.

Then I got a call from Medicaid telling me the refill prescription I wrote was too soon -- that the patient didn't qualify for a refill yet as she had already received 90 tablets. My sympathy dissolved as, confused, I called the pharmacy to confirm the prescription.

Our clinic still uses handwritten prescription pads, and my patient had changed the number of tablets from 30 to 90 -- a simple alteration, and a misdemeanor or felony, depending on the state.

My patient had also changed a Percocet prescription from her chemotherapy doctor. She spent four days in jail and missed four radiation treatments.

Prescription forging happens. And while doctors are aware of the problem, we don't often consider it at the point of care -- the moment patients tell us they're in pain. A 2011 survey from Yale University found nearly a third of patients who abused narcotic painkillers reported obtaining them from a doctor.

Do I think my patient was abusing Percocet? Maybe, but the answer isn't quite that easy. Maybe she had more pain and was afraid to tell us. Maybe we had unconsciously communicated that her pain should have been well-controlled with the drugs we gave her. Or maybe she was selling the extra pills to help pay for her treatment.

So what was I to do when she returned for radiation treatment after her release from jail? She still had cancer, still had pain from her operation and was still undergoing daily treatment. Most important, she was still my patient.

My attending physician took over the patient's pain management and drafted a pain contract -- a document that detailed what medication would be prescribed, who would prescribe it, along with rules that the patient agreed to follow. We also kept close contact with the patient's other providers.

I keep hoping that our clinic will switch to electronic prescribing, which would make it harder for patients to alter prescriptions.

But while prescription drug abuse is a problem and needs to be recognized, the reasons doctors prescribe painkillers should not be forgotten.

Dr. Norleena Gullett is a resident physician in the Department of Radiation Oncology at Indiana University, The Simon Cancer Center