In a recent Center for Practical Bioethics study published in the Journal of Pain Medicine (September, 2008) it was discovered that in recent years, doctors are rarely criminally prosecuted or sanctioned in connection with the prescribing of narcotic painkillers. The study found that between the years of 1998 and 2006, only 725 doctors, or about 0.1% of practicing physicians, have been prosecuted or sanctioned by state medical boards for charges arising from illegally or improperly prescribing narcotics. The primary reason behind such low levels of prosecution was fear of the "chilling effect", as past studies have suggested that doctors, fearful of drawing legal scrutiny, may not adequately treat patients.
Additionally, the issue has become amplified because of several highly publicized prosecutions of doctors accused of selling narcotics like OxyContin, Percocet and Vicodin, or recklessly prescribing them. Some news accounts about those cases have also contended that they were part of a broader, national crackdown against doctors who treat pain patients.
My take on this whole issue is this: with the huge black market out there for pain prescription medication, wouldn't it make logical sense to issue tougher crackdowns on medical professionals with the ability to prescribe such drugs? Chilling effect or not, the HUGE economic (ahem) incentives out there for doctors to illegally prescribe narcostics would lead one to believe that the number of false prescriptions have and will steadily increase to follow black market demand. After all, medical degree or not, many doctors are still human, and the enticement of the all mighty dollar is very difficult for many people to ignore. Therefore, wouldn't the practical solution be to crack down HARDER on the possibility of such situations, rather than to loosen up prosecution in such events?
I understand the chilling effect... we don't want doctors to prescribe less narcotics to those who legitimately need them for health reasons due to fear of liability. However, wouldn't the oaths taken by such doctors (Hypocrates anyone?) to serve the best interests of their patients, be sufficient to counteract the such an effect? Because in the end, if the physician was doing the best they can in the treatment and prescription of medication for their patients, the fear of liability shouldn't be much of a factor at all, right?
Source: http://www.nytimes.com/2008/09/20/us/20pain.html?scp=3&sq=bioethics&st=nyt
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3 comments:
For a doctor to judge when to prescribe a drug for a “pain” is a very difficult proposition and the fact that doctors are “only” being prosecuted at a rate of 0.1% is definitely not a sign doctors are prescribing too few pain medicines. Personally, I find it difficult to believe that any doctor that has given many years of his/her life and invested a great amount of money in education would find it beneficial to jeopardize this by prescribing unnecessary or illegal medicines. Also, I do think that there is a distinct possibility that doctors could be fearful of liability for too loosely prescribing drugs. However, I do not think that the solution is the critique of prescriptions by doctors because there is no evidence at all that doctors (“medical degree or not”) are prescribing drugs that are unnecessary or should be subject to prosecution. I believe that the critique should arise under the overall idea of malpractice in the medical field. There appears to be many more issues that exist in medical insurance than in too few doctors being sued for medical malpractice for prescribing subjective pain medicines.
It’s good to know that less than 0.1% of practicing physicians criminally abuse their power to prescribe controlled-substances. But this finding in no way suggests to me that physicians are under-prescribing needed pain medication or that law enforcement official have become lax in pursuing criminal behavior. I think it more likely that there is limited criminal activity to prosecute since: (1) the FDA and DEA are doing their respective jobs in tightly regulating the distribution of controlled-substances and (2) very few physicians are, in fact, criminals - or criminally greedy.
Do studies really say that, in our criminal justice system, doctors are not prosecuted for drug trafficking so that other doctors will adequately medicate their own patients? ... seriously?
PJM
I find it unlikely that the principal source of this problem is with corrupt doctors but rather with lax prescription standards. The higher strength preparation of Oxycontin that prompted patterns of drug abuse and black market sales has only been around since 1995. My concern is that in this limited period, the medical profession has not yet found a safe and effective standard for the distribution of the higher strength preparation.
According to a 2005 industry study, only 45% of Oxycontin prescriptions were taken as directed.
http://particleboard/p/articles/mi_m0CYD/is_8_40/AI_n13675076
Through the use of urine samples from 5% of the nation's outpatient pain clinics, the study found that 40% of the prescriptions were shared with other patients while 15% of the prescriptions were being sold in the black market. If almost 50% of Oxycontin patients feel all right dispensing their medication, the inference could be made that almost 50% of patients are being over-prescribed. Just last week my girlfriend threw away the 30 Oxycontin pills remaining from her tonsillectomy.
Although, I realize doctors would prefer to err on the side of over-prescription. This error can be deadly. In September '07, my best friend from grade school ended up with someone else's over-prescription of Oxycontin pills. As a result, he died from combining these pills with anti-depressants and alcohol.
On the one hand a blog may be the wrong place to share such information. On the other hand, maybe a bioethics blog is the exact right place to share such information? Either way it's important to me that people are aware of what's at stake in these type of debates.
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