By Michael Hill
Opioid manufacturing and prescribing last year became a $9 billion industry. It’s where profits meet pain pills and a major concern about over prescribing.
“We really have to strongly consider who it is you offer opiates to, and who you don’t,” Dr. Joe Contreras, from Hackensack University Medical Center, said.
Contreras prescribes opiates to his patients with and without cancer.
“In fact I have had a patient with cancer pain who has overdosed, but in discussion we found out that it was accidental. We’re much more careful,” he said.
A Boston Medical Center survey of 2,800 patients who had overdosed on opioids found 91 percent were still prescribed opioids, and many by the same doctor. Seven percent overdosed again.
“We were shocked and alarmed at how frequent and high that continued prescribing rate was,” Dr. Mark Larochelle said.
Larochelle led the study of non-cancer patients. He and others say it points to a need for better communication and information sharing because right now if patients overdose their doctor may not find out.
The study hits at the crux of the issue: how are doctors supposed to know their patients have overdosed on opioids they prescribed.
“If it were within my institution, and within our network, I would absolutely find out about it. If not, I’d have to rely on the patient volunteering that information to me,” Contreras said. When asked if that’s a flaw in the system, he said, “It absolutely is.”
The American Academy of Pain Management says legislation may hold an answer.
“Around the country we’ve all been working towards an electronic health record, but the trouble with those records is that they often don’t interface or talk well to one another. We do have prescription monitoring services in 49 out of the 50 states that tell us when patients receive prescriptions for opioids. Unfortunately, those prescription monitoring services don’t include information about overdose and that’s something that the American Academy of Pain Management that we’re considering as a policy measure to ask states to put that in place,” Clay Jackson said.
New Jersey launched its prescription monitoring program last year and Dr. Contreras says it works well to determine doctor shopping and all that’s prescribed to patients. He says going forward the whole equation needs more informed consent for information sharing, doctor-patient communication, institution to institution communication and monitoring. Another key component, according to the Partnership for a Drug-Free New Jersey, is educating doctors.
“I think that they’re not informed because for many years there was a misconception about the safety of these drugs. I think we’re learning more and more as the country and the state are now experiencing epidemic levels of abuse of opioids. We’re learning that these are very dangerous drugs and information should be given out to patients about how addictive they can be,” said Angelo Valente, Executive Director of Partnership for a Drug-Free New Jersey.
Two bills to have doctors inform patients both died in the legislature. So starting Jan. 1 the Partnership is taking it upon itself to inform the public with a series of ads, asking parents if they would give their child heroin, an opioid, for a broken arm, sports injury or root canal.