Doctor's Offices Can Help Stem Abuse Of Narcotic Painkillers

Every day, thousands of doctors around the United States walk a tightrope stretched between their duty to help patients in pain -- and the risk of abetting illegal and life-destroying drug addiction and dependence, and losing their medical license for doing so.

They walk this tightrope every time a patient asks for a prescription for a powerful opioid narcotic painkiller, such as Oxycontin or Vicodin. These drugs have eased the pain of millions, but have also become lucrative street drugs that are used by millions of people not for pain control, but to get high.

Now, a new study from the University of Michigan and the Ohio State University shows how doctors and their office staff might be able to keep their balance.

Today at the meeting of the Society for General Internal Medicine, a U-M physician will present the results of an approach she designed and implemented while at OSU.

The results show how a busy multi-physician clinic was able to get a better handle on which patients were misusing opioid medications - and steer dependent patients to treatment - through a policy that logged and carefully screened all patients who were receiving the drugs for non-cancer pain. The clinic also required patients and doctors to sign an agreement about conditions for receiving such medicines. The initiative helped identify patients who were using other illicit drugs, which can interact dangerously with narcotic painkillers.

In all, the study revealed that 35 percent of the 167 patients in the clinic's opioid registry violated the new policy in some way - with the most common violations being a mandatory urine test that showed illegal street drug use, or a check of state prescription records that showed they were getting the drugs from more than one physician at the same time.

Patients who were receiving Oxycontin or another medicine that contained its active ingredient, oxycodone, were twice as likely as other opioid registry patients to violate the clinic policy in some way.

"Many of us in the clinic were surprised at what we found, because a doctor's job is first and foremost to trust the patient as they tell us about their pain," says study author Jennifer Meddings, M.D., who implemented the policy in collaboration with OSU pharmacist Stuart Beatty, Pharm.D., and OSU internal medicine residency program director Catherine Lucey, M.D. Meddings, now a clinical lecturer in the Division of General Medicine at U-M Medical School, continues, "But in order to confront this issue, and protect our ability to prescribe these drugs to the patients who truly need them, we need to have a uniform approach for all patients."

Meddings is now working with her U-M colleagues to improve implementation of a similar program in the Taubman General Medicine clinic of the U-M Health System, with hopes of having it spread to other U-M clinics -- as it did at OSU. She also hopes to study the effectiveness of such a policy more fully and prospectively.

She led the design and implementation of the policy while she was chief resident of internal medicine at OSU, treating patients at a busy resident-staffed, faculty-supervised clinic. In such a clinic, where a patient is not likely to see the same doctor at every visit, the risk of prescription opioid misuse may be higher.