I am doing a research paper on physicians who over-prescribe narcotics for veterans with legitimate chronic pain issues that are service-related.  Why are physicians not held responsible for...

I am doing a research paper on physicians who over-prescribe narcotics for veterans with legitimate chronic pain issues that are service-related.  Why are physicians not held responsible for getting patients addicted to narcotics because they over-prescribed the drugs in the first place?

Expert Answers
kipling2448 eNotes educator| Certified Educator

It's very difficult to hold a physician accountable for over-prescribing medications of any kind to any category of patient. In the case of medications prescribed for individuals suffering from chronic pain, the case is even more difficult, especially when the patients are military personnel suffering from service-related illnesses or injuries. As long as the physician is acting in the bests interest of the patient, then the issue of addiction may be secondary to the issue for which the patient is seeking assistance in the first place, namely, pain associated with wounds, illnesses, or other service-related injuries. 

Part of the problems is that the human body, and especially the central nervous system, which is intricately connected to the functioning of the brain, is so complex and differs so much from one patient to another. A patient in pain simply wants that discomfort alleviated. Under such conditions, the risks of addiction may seem minor, until that addiction takes place. Physicians are highly-trained professionals, but they are not gods. They error, and they prescribe medications for patients who demand relief from discomfort as the easiest, cheapest and least invasive means of delivering that relief. Surgery is generally considered the more extreme, higher-risk option, so a combination of medications and physical therapy are usually prescribed. Chronic pain conditions, however, do not lend themselves to easy or simple rectification. By their nature, they are difficult to repair. After all, the human body was not designed to absorb bullets, shrapnel and radioactive substances from depleted-uranium rounds. Wounds sustained in combat, or in realistic training exercises that may involve live rounds or inadvertent helicopter crashes are unnatural conditions and the average human anatomy does not completely heal following such injuries. To expect physicians, then, to know exactly what, and in what doses, medications to prescribe is asking a lot of mere mortals.

As long as physicians are not acting maliciously in prescribing medications, especially those intended to address pain, than they are given the benefit of the doubt most of the time. Anybody studying the issue of over-prescription of pain medications would do well to take a close look at the oxycontin issue, in which a widely-prescribed and highly-addictive pain medication became the center of a regulatory and legal storm when patients did in fact become addicted. Is that the fault of the prescribing physicians? Sometimes, it probably is, but not always, and parsing distinctions is not easy.

kipling2448 eNotes educator| Certified Educator

Another issue you might want to research, if you are interested in looking at heroin and prescription narcotic addiction, is the history of methadone, a synthetic alternative to opiates that created its own form of addiction. Whether one is better off addicted to heroin or methadone, putting aside "dirty needle" issues and AIDS, is worth considering given how addictive is the "cure" for heroin addiction. Opiates have been used for medicinal purposes for thousands of years (see the informative article at this link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC46725/pdf/pnas01469-0022.pdf) and have invariably led to addictions in their various forms, from opium to morphine to heroin. Opiates have been used for legitimate pain-relief purposes, and morphine is commonly used today by licensed physicians for relief of intense pain, but their addictive nature forever lies out there demanding redress.

Another angle to pursue is the debate regarding legalization (or, at a minimum, decriminalization) of currently-illegal narcotics, a contentious issue without resolution. The "war on drugs" has cost taxpayers billions of dollars without diminishing the volume of such drugs entering our country from outside. What would be the effect on addiction of legalization? Would legalized narcotics like cocaine and heroin decrease the number of addicts, and would the costs associated with treatment of addicts decrease? Nobody knows. Would legal access to such substances diminish their attractiveness to youth? Probably not, as cigarette consumption remains ridiculously high despite the ease of their purchase.