Rx drug use: Treat, don't indict

Robert MabeeGovernment involvement with drugs has a long and troubled history. In the latest effort to combat the growth of prescription drug abuse and enforce stiffer criminal penalties for the distribution or abuse of prescription drugs, new regulations have been initiated nationwide.   

In theory, this was a good idea. But the timing was a bit odd. At the same time as the United States decided to clamp down on patients who may have become therapeutically addicted to psychotropic or pain medications, there was a growing push to legalize cannabis, a Schedule I drug used “recreationally.”

Pharmacists and physicians are now concerned that law enforcement might find their decisions to prescribe or dispense a controlled substance as criminal.

See also: Filling prescriptions for controlled substances: Establish a protocol

The role of treatment providers 

Confusion of roles leads to poor decisions. Physicians and pharmacists are not policemen. Their job is to provide preferred treatment to all patients. Preferred treatment is the treatment you want for yourself and your family. Not the most expensive treatment, but the one that’s most effective. Most pain medications are inexpensive.

The decision to treat addiction as a crime is not a subjective approach with a clinical perspective. Patients with legitimate chronic pain or terminal illness are always at risk of developing therapeutic addiction. And terminal illness and the associated therapeutic addiction are by definition self-limiting.

Physicians, however, have always been reluctant to prescribe pain medications. My brother used to make regular visits to a friend and mentor who had been a clinical professor when my brother was in med school. The older surgeon, as a patient in hospice, regretted that he had not been more aggressive in treating pain during his career. Faced with the pain that often accompanies an end-stage disease, he realized that he could have given his patients better care if he had provided appropriate pain control.  

See also: The pain-med choke point

Law vs. medicine

A well-documented dilemma unfolds when doctors decide to practice law and lawyers decide to practice medicine. Lawyers and judges are trained to take an adversarial approach to decision-making. Physicians are trained in a collegial environment that encourages decision-making by consensus. Doctors’ perception of the risk of malpractice is exaggerated. In reality they are at greater risk of being struck by lightning.

Healthcare administrators nurture this misconception and heighten physician paranoia. They inculcate a siege mentality and encourage a “team loyalty” that requires silence about any act of medical negligence. Some speculate that “fellow team members” are willing to engage in technical perjury to preserve their employers’ assets, perhaps motivated by hope of a bonus in the future.

The revenue angle

The main reason administrators encourage more “defensive medicine” is that additional expensive tests generate more revenue, although by some estimates, malpractice claims constitute less than 3 % of total medical sales.

In an effort to appear diligent, hospital administrators encourage defensive medicine. By ordering redundant or unnecessary tests, physicians can more than double a hospital’s revenue. Increasing revenue by more than 100% to protect against a potential loss of less than 3% is a bonanza in revenue for hospitals and “justifies” multi-million-dollar salaries for hospital CEOs.

Patients with employer-sponsored insurance or Medicaid are dazzled by the abundance of caution and a perception that no expense is being spared in their care. Patients without resources are hounded by collection activity until they are forced into bankruptcy and quiet humiliation.

The bottom line: Hospitals are bloated with additional revenue and patients are denied adequate pain medication. The hospital system would make very little revenue from the pain medication, and the complaints of pain-medicated patients who are injured or dying are discounted as “weakness of character” or “addiction.”

Guess who loses

Once again bureaucrats and medicine have collided, and patients are the losers. Ironically, older taxpayers who have worked and paid taxes to support government for years are being denied adequate pain management at life’s end, while bureaucrats are finding it cost-effective to manage behavior problems in poor children through the use of expensive mood-altering medications.

Government involvement in healthcare is rarely positive. It always increases cost and reduces real care for the patients. Patients suffer, while the executives of the political-medical complex prosper.      

Robert L. Mabeeis a pharmacist and attorney practicing in Sioux Falls, S.D. He also holds an MBA. Contact him at rlmabee@mabeelaw.com.