- The opioid crisis is extremely complex and that a single, simple cause cannot be identified
- Purdue pharma has to carry the majority of the blame for the opioid crisis, but others are also to blame.
- Physicians should have known that ANY opioid is addictive and PBM’s should have alerted the FDA and DEA to high volumes of the painkillers being ordered by local pharmacies.
- Psychology Today says “pressure from patients, is likely to also be part of the motivation for unnecessary or excessive opioid prescribing”.
According to Psychology Today “in the emergency department (ED), which is where many opioid prescriptions originate, doctors often have little time to assess patients’ pain and understand their risk of dependency and addiction. In fact, ED doctors are usually under enormous pressure to see as many patients as possible and are often evaluated based on how many patients they see rather than on the quality of care they provide. Patients are also asked to fill out satisfaction surveys as they depart the ED, including questions about whether they feel their pain has been addressed and resolved. Because doctors are evaluated based in part on the scores they get on these surveys, those questions provide an incentive to overprescribe potent analgesics. All of these factors – a medical culture that emphasizes the need for pills to treat pain, lack of training on pain management for physicians, a disjointed healthcare system, and time pressure on doctors – have come together to create a situation ripe with opportunities for vast overprescription of opioids”.
Where is the AMA?
An exclusive analysis by CNN and researchers at Harvard University found that opioid manufacturers are paying physicians huge sums of money — and the more opioids a doctor prescribes, the more money he or she makes.
The CNN/Harvard analysis looked at 2014 and 2015, during which time more than 811,000 doctors wrote prescriptions to Medicare patients. Of those, nearly half wrote at least one prescription for opioids.Fifty-four percent of those doctors — more than 200,000 physicians — received a payment from pharmaceutical companies that make opioids.
Among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments. Among those in the top fifth percentile, 84% received payments. Among the very biggest prescribers — those in the top 10th of 1% — 95% received payments.
So where is the punishment for these doctors? Where is the AMA calling them out?
In the meantime Purdue Pharma has fired its entire sales force for doing what they were trained to do. The fine for Purdue cannot be big enough, but shouldn’t we also go after PDM’s and distributors who were shipping large amounts of opioids to pharmacies? Shouldn’t there have been a policy, by insurers and pharmacy chains to limit opioid Rx’s to 2?
Of course the downside to all this is that there are people who have a real need for pain control. They are finding it harder to get Rx’s because of abuse, but let’s not pretend that Purdue pharma alone is responsible. Doctors should have known better.