To Prescribe or Not To Prescribe: The Doctor's Dilemma

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To Prescribe or Not To Prescribe: The Doctor’s Dilemma

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Amid an epidemic of opioid addiction, fingers are increasingly being pointed at doctors. Some whose patients have died of opiate-related overdoses have even been charged with criminal offenses. Just last month, a Santa Barbara, California doctor known as the “Candy Man” was convicted of 79 counts of writing prescriptions for powerful painkillers such as OxyContin and Dilaudid without a legitimate medical purpose. In Los Angeles, Dr. Hsiu-Ying “Lisa” Tseng is now on trial for murder in the deaths of three patients to whom she prescribed painkillers.

It’s enough to make you think doctors are as much a part of the problem of painkiller abuse as the solution, that Hippocratic Oath of “First do no harm” reduced to mere boilerplate. But could the medical profession actually be getting a bad rap?

An MD Gets Real…Torn

I was really excited to finally read an account of a reputable physician’s internal struggle with prescribing painkillers. Author-doctor-professor Danielle Ofri wrote about dealing with a patient who suddenly asked for a seriously strong narcotic pain medication.

The patient, an elderly African-American man and former heroin addict, claimed the pain specialist who’d been prescribing him oxycodone for many years had closed his clinic. After trying less potent drugs and physical therapy, Oxy was apparently the only relief this man could experience from an old construction-related back injury. Ofri had known the patient for six months but hadn’t previously been aware of his chronic back pain. She knew if she refused to give him the prescription, it might affect his trust in her. But if she went ahead and wrote the script, she could potentially be supplying a real drug addict real drugs.

“In the end I had to decide whether I was more ethically comfortable denying meds to a patient in legitimate pain or inadvertently supplying an addict,” Ofri writes.

She ended up writing the prescription but scheduled another visit to discuss his pain issues in more depth.

As Ofri points out, there is no quantifiable way to verify someone’s level of chronic pain. Physicians have to rely on the symptoms that the patient describes. That leaves the doctor in the position of having to decide the patient’s credibility and the chronic pain sufferer at the mercy of the doctor’s judgment.

Different Strokes for Different Docs

You can play the blame game all day long but I think a lot depends on the individual doctor. Some are impulsive and lax while others are rigid, by-the-medical-textbook rule followers. Some are quick to bust out the prescription pad but some are hesitant to dole out any sort of pharmaceutical unless absolutely necessary. Just like I’ve had some doctors over the years tell me it’s totally fine to drink on antidepressants and others who (wisely) said absolutely not, if you want them to work. I also had a doctor who insisted I try everything under the sun, from more exercise to a plant-based diet, to deal with my depression before succumbing to popping Wellbutrin.

Obviously, when it comes to psych meds, there are some patients who no doubt 100 percent need them to function at a basic level. But with other health issues, I’m not so sure we aren’t continuing to just treat the symptom rather than the cause. Shouldn’t we be addressing why we are so regularly developing the health problems that Ofri says her patient suffers from like diabetes, hypertension, high cholesterol and obesity? Healthy management of stress, getting enough exercise and eating right are never emphasized by the pharmaceutical companies.

The doctors who recommend a more holistic regimen and a healthier lifestyle to patients are doing everyone a favor since so much of our healthcare spending is associated with illnesses that could have been avoided with better choices (Type 2 diabetes, aka Pizza Hut, anyone?). But when it comes to a patient suffering from excruciating back pain, can a doctor who practices Western medicine really feel right about prescribing some acupuncture and more fruits and vegetables? If the pain is way past the point of benefiting from holistic treatment, suggesting those remedies to that patient may be futile.

Not All ‘Candy Men’

I was much more of a binge drinker than a daily drinker or drug-doer and I never experienced physical withdrawal symptoms when I quit drinking (emotional withdrawal symptoms were in full swing, however) but I still have what the layman calls an “addictive personality.” When my pleasure zone gets amped up, I want to keep it amped. It’s NEVER just one piece of Hershey’s chocolate or just one cigarette. As one of our nations most beloved pop artists Britney Spears so eloquently says, “Gimme more.”

So, yes, the “Mr. W” patient Dr. Ofri talks about probably is a little “addicted” to that oxycodone in the way that anybody with an addictive history would be. I’m sure he’s gotten used to his numbing agent in a similar way that he got used to his heroin highs. But perhaps he isn’t at the level of overdoing it yet and Ofri does not specify the strength of what he’d been taking or what she prescribed. The result of not prescribing him the medication may be worse for all parties involved than prescribing it.

No doubt morally bankrupt doctors exist but does that mean the medical profession as a whole should be blamed for the opioid epidemic? They’re not all “Candy Men.”

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2 Comments

  1. Pingback: Can We Stop Prescribing Seniors Opiates? | Dana Dunbaugh Burnell

  2. Advil for post-op pain!
    That’s beyond ridiculous!
    I know a few very lucky individuals for whom Advil will work for even the most severe pain, but everyone else (that’s the vast majority of us) require opioids after surgery.
    This so-called “epidemic ” has been blown out of proportion thanks to Andrew Kolodny and his minions. Do we want to go back to the 90’s when more people bled to death from overuse of NSAIDS like Advil than died from opioid overdose.
    The kind of thinking espoused Marc Ferris is causing much unnecessary pain and anguish among authentic pain patients.

  3. Before I was released from the hospital after having my gallbladder removed the doctor asked me what kind of pain medication I wanted, and listed three or four high-powered drugs. I asked him if Advil would be enough and he said sure.

    I thought the nurses were going to faint.

    Dare I say this is an epidemic?

    And yes, Advil worked just fine.

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About Author

Mary Patterson Broome

Mary Patterson Broome is the Editor-in-Chief of RehabReviews.com/AfterParty Magazine and has also written for Women's Health Magazine Online, AOL and WE TV. She has done stand-up comedy at clubs, colleges, casinos and festivals across the country and internationally for over a decade. Originally from southern Alabama, she now reluctantly calls Los Angeles home.

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