A Medscape report that explores how physicians prioritize substance abuse among leading American social issues also reveals their divergent views about a proper role in pain management through opioids.
The Centers for Disease Control and Prevention last month updated its guidelines for prescribing opioids to adults with acute and chronic pain. In part, the new guidelines 1) urge clinicians to maximize use of nonopioid therapies, 2) support lowest effective dosages and immediate-release drugs when physicians do turn to opioids, and 3) ask doctors to prescribe no greater quantity of opioids than needed for the expected duration of the patient’s pain.
Some survey respondents in the “Substance and Opioid Abuse Report 2022: Drugs and Alcohol Are Challenging Problems for Physicians and Their Patients” believe doctors still overfocus on pain management and 0-to-10 pain scales, even during the nation’s opioid crisis.
“It’s easy to become addicted to opioids when [physicians are] using a pain scale in the hospital and stating that post-op patients should be encouraged to use meds when they are at a 3,” an ob/gyn said. “If patients were told to expect significant post-op pain going into surgery, then they would have appropriate expectations post-op.”
“Our MIPS forms tell us that we need to present a plan if a patient complains of pain greater than zero,” a rheumatologist respondent added. “Primary care people feel compelled to treat pain. This has resulted in a far more cavalier use of opiates, because other medications have failed.”
And a toxicologist felt continuing “pressure on doctors for their overprescribing during the opioid crisis” would be a positive for society.
Beware Unintended Consequences
But some physicians in the Medscape survey felt the pendulum needs to swing back to more aggressive pain management, including prescribing opioids when appropriate. “Chronic pain and cancer pain patients are often undertreated by MDs, pharmacists, nurses, and support staff,” one internist argued. “These caregivers are not educated properly on pain control, and that is so unfortunate.”
A number of other doctors pointed to unintended consequences for which they said champions of stricter oversight of opioid prescribing cannot avoid responsibility.
“I think the government’s crackdown on physicians…has actually worsened” the opioid crisis, a gastroenterologist said. “Now, people are more often going to the streets and are getting fentanyl-laced drugs, resulting in accidental deaths. It’s a big problem.”
That viewpoint was backed by an orthopedic surgeon.
“Discouraging legal prescriptions doesn’t cure opioid use disorder,” he argued. “Other doctors and I are afraid to prescribe opioids, which is a boon to the illegal drug trade. Opioid prescriptions have been nearly cut in half in 10 years due to the new guidelines and rules, but overdoses and illegal opioids have nearly doubled.”
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