Physicians Knowingly Prescribing Opioids to Addicts, Says Doctor

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According to a compelling perspective written by Anna Lembke, MD, of Stanford University, many doctors prescribe opioids to known addicts because the alternatives are just not all that attractive.

Why doctors' attitudes have changed

Writing in the New England Journal of Medicine, Lembke argues that attitudes among doctors have changed over the last decade thanks to a number of factors: compassionate care necessarily includes pain management; doctors consider addiction counseling to be extremely time-consuming and they aren't being appropriately compensated for it; and doctors act out of a concern for their ratings and reviews on consumer rating sites, preferring to prescribe pain pills to patients they know are addicted if it means avoiding a bad review, which can cut into their bottom line and threaten job security.

"Treatment of pain is held up as the holy grail of compassionate medical care," writes Lembke, and the general zeitgeist is that "all suffering is avoidable."

The result is that addiction to opioid painkillers is on the rise, and doctors are part of the problem, not the solution.

Recommendation for change

Lembke recommends that all clinicians attend a course on addiction; that they have access to prescription drug monitoring programs (PDMPs) and be required to check with them before writing controlled prescriptions; and that they be made aware of billing codes that can get them reimbursed for addiction counseling.

She believes that the wider problem "will be solved only when the threat of public and legal censure for not treating addiction is equal to that for not treating pain, and when treating addiction is financially compensated on a par with care for other illnesses."

Source: NEJM

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