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Painkiller Prescription Monitoring: More Harm Than Good?



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You might remember last week when we talked about the severity of the opioid epidemic. More than 33,000 overdose deaths a year is enough evidence that the opioid addiction epidemic is not over, far from it. In nearly every state, similar-looking laws have started to appear that allow health professionals to see if a patient currently has, had, or is ambitiously seeking a painkiller prescription. This law is the latest in an effort to curb unnecessary painkiller prescriptions. So why has it drawn controversy?

Painkiller Monitoring – Is It Working?

It is certainly pleasant to imagine that one policy could reverse the epidemic completely and bury it somewhere too deep to retrieve it. But a problem like the opioid addiction bloom, now claiming an average of 91 lives per day in the United States, is more like opening Pandora’s Box. Any number of causes and effects are at play in this tragic situation. While prescription monitoring should work in principle, it is too soon to tell if it properly prevents addictions as much as it prevents people from receiving the medicine they need.

Bear in mind the point that that addictions afflict individuals, not groups of individuals, at least from a medical point of view. As such, recovery requires an individual commitment that is supported by any number of professionals, family members and friends. That doesn’t change, no matter what policies come out of the halls of government.

Still, government may have stumbled across a popular, if controversial idea with the prescription drug monitoring programs (PDMPs). In states with the more strident, mandated programs, in which doctors are required to check in with an electronic data bank before writing a prescription for opioid-based painkillers, the results are even more promising, according to a new study, than states where the practice is voluntary.

All states but Missouri now have either required or voluntary PDMPs, according to a Reuters report from February 2017. Meanwhile, the study, published in the peer-reviewed Addictive Behaviors journal, found that states in which doctors are required to participate in the drug monitoring system, has reduced what is called “doctor shopping” by 80 percent. In states where the systems are voluntary, “doctor shopping” has been reduced by 56 percent. Whether these people turn to “after-market” opioids like heroin or kratom remains to be seen.

Will Opioid Regulation Worsen The Opioid Epidemic?

But the new programs come complete with various controversies attached. The first is simply the right to privacy. Reporting doctors’ prescription writing habits have long been illegal in New Hampshire, for example, owing to the pharmaceutical companies practice of buying this information and using it to market their products to doctors. Some believe this violates a patient’s right to privacy – even though the information on patients is coded – while others believe it simply corrupts the doctor’s ability to make medical-based decisions about what drugs to prescribe, since the data gives drug marketers an inside track on what a doctor likes to prescribe.

The other controversy directly involves the opioid epidemic. The new programs, after all, are meant to identify the behavior of patients and to identify them as high-risk of addiction.

So what about patients with chronic pain who happens to have addiction issues? Do you cut them off from pain medication? Aren’t people with addiction issues allowed to treat chronic pain effectively?

Would it contribute to a person’s addiction problem by cutting off their pain medicine and forcing them to reach for street drugs or live in chronic pain?

With PDMPs, do those with addictions give up their rights as people? As patients? Do doctors give up the right to prescribe what they feel is medically appropriate based on their knowledge of a patient – even patients with addiction issues?

Further, the Patient Protection and Affordable Care Act of 2010 makes it illegal for insurance companies to deny insurance to people based on pre-existing conditions. What if you don’t even have a long-term, pre-existing condition, but had to shop around for another doctor for any number of legitimate reasons, but were then tagged as a “high risk” patient, because you went to a second doctor for pain medication? You can’t be denied coverage, but would your insurance rates go up?

What Efforts Can Be Expected In The Future?

Politicians, of course, often have to make tough choices on policies, especially when words like epidemic and skyrocketing overdose rates come into play.

This brings up another way to politicize the debate over PDMPs. For now, we find that “certain addictive drugs” is a category of drugs subject to human error. Which drugs should trigger a mandatory call to ta data bank and which ones are doctors allowed to prescribe without checking? Will pharmaceutical companies now start designing drugs that come up to, but do not cross the line into mandatory reporting lists?

The line of controversy with PDMPs is not unwarranted, but it does beg the question whether it is accurate. In recent months, the opioid epidemic has spun into new heights, and it is an apparent problem that needs a more substantial solution. PDMPs may be a part of the solution or part of the problem, but both sides can agree that it is not a complete solution – or failure.

For those struggling with addiction currently, personal recovery is possible, even before the country recovers as a whole. If you are interested in starting your journey, you’ve come to the right place.


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