Preventing Narcotic Misuse

Lynn R. Webster, MD

Disclosures

March 15, 2010

Question

Why do we not have better collaboration among prescribers, pharmacies, and law enforcement to stop the substantial flow of prescription narcotics into the community?

Response from Lynn R. Webster, MD
Medical Director, Lifetree Clinical Research and Pain Clinic, Salt Lake City, Utah

This is a good question because such partnerships are vital to stopping the damage of prescription opioid misuse. Problems arise when professionals in each field see only the necessity of performing their own functions but miss the big picture. Prescribers are dedicated to treating pain and are not qualified as drug enforcers. Law enforcement rightly sees its job as fighting criminal diversion but in the course of doing that job may fail to appreciate the medical benefits of opioids and may treat addiction as a criminal problem rather than a medical issue. Pharmacists are obliged to challenge any prescription for a Schedule II drug they judge as looking suspicious but do not have access to a patient's medical record, are not trained in pain management, and often think they have little authority to intervene in a physician/patient relationship. The bottom line is that each group appears to share different goals, although public health and safety are truly the common goals.

The needs are apparent: Prescribers should acknowledge the potential damage of prescription opioid misuse and diversion and cooperate in fighting diversion. For example, prescribers and pharmacists could discuss by phone any suspicions of "doctor shopping." This could be done without fear of violating the Health Insurance Portability and Accountability Act, as long as discussions about a patient are driven by concern for patient care. Prescribers should be familiar with all opioid-related state and federal laws, utilize prescription monitoring if available, and document all aspects of opioid therapy. Education on the principles of pain management is needed for law-enforcement officials, particularly when decisions may be ruled by a philosophy of pure enforcement.

These are examples of how partnerships can work. However, it takes time and resources to share information, and incentives to do so are lacking. The unfortunate result is that when communication does occur, it is sometimes reduced to finger-pointing as each side attempts to blame the other for opioid-related problems.

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