Primary Care Doctors Grapple With Treating Pain as Prescription Drug Abuse Grows

Some pain experts say doctors not adequately educated about opioids are contributing to the problem of prescription drug abuse by overprescribing the drugs. Because there are relatively few pain specialists in the United States, pain management often is the responsibility of primary care doctors, according to American Medical News.

“Doctors have caused an epidemic, not out of malicious intent but out of a desire to treat pain compassionately,” Andrew Kolodny, MD, President of Physicians for Responsible Opioid Prescribing, told the publication. “We overprescribed and created a public health crisis.”

The number of Americans who died from overdoses of prescription painkillers more than tripled in the past decade, according to the Centers for Disease Control and Prevention (CDC). More people now die from painkillers than from heroin and cocaine combined. An estimated 14,800 people died in the United States from painkiller overdoses in 2008, a more than threefold jump from the 4,000 deaths recorded in 1999, the CDC said in a new report.

Family physician S. Hughes Melton, MD, who practices in Lebanon, Virginia, is seeing more healthy people in their 20s and 30s who are asking for painkillers. He conducts a thorough exam of everyone who asks for pain medication, including an X-ray to look for the source of pain. He examines their medical and prescription drug records, and requires a urine drug test. He does not prescribe pain medicine while he is waiting for the test results.

Steven Crawford, MD, a family physician in Oklahoma City, says it is often hard to verify patients’ complaints of pain. He points out headaches, back pain and limb pain cannot always be seen through a physical exam or imaging. He also says it can be difficult to determine whether pain can be managed with a non-opioid medication. Doctors do not want to leave patients who are in pain to suffer without adequate treatment, he adds.