Have We Gone Too Far With Prescribing Narcotics for Pain Management?

The New York Times (4/9/2012) reports, “The most aggressive effort is under way here in Washington, where lawmakers last year imposed new requirements on doctors to refer patients taking high dosages of opioids—which include hydrocodone, fentanyl, methadone and oxycodone, the active ingredient in OxyContin—for evaluation by a pain specialist if their underlying condition is not improving … even before the new provisions took effect, some doctors stopped treating pain patients, and more have followed suit.” The article adds, “Washington State officials acknowledge some of the law’s early deficiencies, including its sometimes indiscriminate application, and they are seeking to address them.”

In our efforts to promote good pain management, have we gone too far? This article seems to suggest that we have. Although not all medical professionals agree, the article suggests that more people are coming to that conclusion.

I’ve long observed that in health care our approach to care—or even public policy—is like a pendulum. When it swings too far we push it back. Is that what is happening with pain management today? I admit that this is not my area of expertise, but it’s hard not to think that the over-promotion of pain medicine, along with the desire to help with good pain management by prescribing narcotics, could have led to overuse of these drugs. The results are unnecessary deaths and perhaps even poor patient management. The article is based on the state of Washington’s law which requires doctors to refer patients on high doses of narcotics to a pain specialist. Apparently, other states are considering similar legislation.

Some pain experts are beginning to realize that long-term outcomes for patients treated with high doses of opioids are appalling. Although I would rather see us clean up our own mess than have the government mandate actions with laws, maybe that approach is necessary to get our attention. I think the pendulum has swung too far with the prescribing of narcotics. Changes are needed—and unless we make them voluntarily, the situation may require the government’s intervention. What do you think?