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?

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kipling2448 | (Level 3) Educator Emeritus

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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.

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beachlife24 | Student, Undergraduate | eNotes Newbie

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Thank you very much and I will look at what you said about Oxycontin.  That is one of the things I had planned on looking at.  I am also looking at the link between prescription narcotic addiction and the rise in Heroin use, which has also increased HIV infection rates as well.  I am starting off with this and over the next 2 years turn it into my Senior Thesis for both my major and the Honors Program.  I am actually starting this in one of my honors program classes, Social Justice and my professor thinks it is great idea because there is a big problem in our country with addiction.  I have to create an argumentative paper/essay and pick a philosopher and support my argument.  At first I was thinking Kant but now I am not sure and was struggling with how to narrow down to one issue within narcotic addiction and then expand in my other classes for my Senior Thesis.  Thank you for your suggestion about OxyContin.  I think that may be what I use for my social justice paper and as a starting point for further research.  

kipling2448's profile pic

kipling2448 | (Level 3) Educator Emeritus

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"I am also looking at the link between prescription narcotic addiction and the rise in Heroin use, which has also increased HIV infection rates as well."

Another issue about which you might want to look, as you mentioned 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.

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beachlife24 | Student, Undergraduate | eNotes Newbie

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Thank you for the added information it definitely helps me.  I knew that methadone is used to "detox" from heroin use however I didn't realize that methadone also is addictive, so basically it is trading one addiction for another.  I have found quite a bit of information on Suboxone which is intended to treat addiction to opiates however the more information I find the more I see that this is also a very addictive drug as well.  

I read one article about a guy who over seven years ago "tried" his girlfriends Suboxone (she was an addict and told him that you can get a high off of it), he said that he had never taken any type of narcotic in his life thus far and had only ever used marijuana when he was younger.  He said the incredibly high he got from Suboxone (his girlfriend had been prescribed 8 mg pills) was nothing like he had ever experienced and loved it (he said he used a pill cutter and cut it in fours and only took 1 of 4 quartered pills) and he then started on a regular basis asking his girlfriend for more pills and he increasingly had to keep upping the mg's in order to get high. hi girlfriend eventually told him she could no longer give him any of her pills because she needed them.  So she suggested he go see her Suboxone doctor and just tell him that he was addicted to Oxycontin and wanted to get off of it.  So that is exactly what he did and walked away with a prescription for Suboxone and now 7 years later he is still getting a monthly prescription for it, he said he has tried several times to wean himself off of it and for a few weeks it works and he doesn't have any withdrawal symptoms and then inevitably he would have a difficult day at work or was just not feeling good so he would reward himself with a full dose sometimes 2 doses at once because he had been so good with weaning down and it only takes one time of him doing it and he is back to taking the full dose everyday.  Very interesting to read about.  

I can also say that I do have a personal connection and is what inspired me to start researching this topic.  My mother-in-law passed away this past August, the police officer that was first on scene contacted my husband because he is her next of kin and told us they requested and investigator from the Medical Examiners office because the scene looked suspicious (my husband's younger brother found her, we also live in a different state).  

She had survived breast cancer (diagnosed in 2000 and had a double mastectomy along with radiation and Chemo). When that happened her place of employment fired her illegally and subsequently dropped from her health insurance, the hospital where she was being treated left a pic line in her neck when they learned she had no insurance.  She then had a massive MRSA infection which she almost died from they had to cut her one arm from shoulder to wrist and basically fillet it open to drain the infection and had several incisions in her abdomen with draining tubes.  She survived and actually won a malpractice lawsuit.  Since all of that she lived in constant pain everyday and was put on narcotics and was on them well over 10 years.

We knew that she self medicated at times however we justified it as ok because we knew she lived in constant pain, also, if anyone tried to talk to her about self medicating and taking more than prescribed she would just cut them out of her life.  After speaking to the officer on scene and the ME investigator we told them that we knew she was prescribed morphine, Oxycontin and Oxycodone however they could not find any of the bottles of medication.  They told us that they were doing an autopsy because of the suspicious circumstances.  After the autopsy the ME called us and asked us several questions concerning what they saw in her apartment and answered our questions.  My brother in law told several stories of how he found her etc, it came out that he took the narcotics from her apartment before he called 911.  It is all very shady.  The ME told us that she was found crumbled next to her bed with only one sock on.  

We finally got the cause of death a couple of weeks ago which was ruled accidental due to a massive heroin overdose.  When we talked to the ME he said that after getting all of her medical records in January of this year the state she lived in had gone to a statewide data base that showed what doctors are prescribing and what patients are getting.  Turns out she was seeing 2 different pain specialists and five other doctors and getting scripts for narcotics from all of them each month.  I asked how this was even possible because she was on medicare and receiving state assistance how was that not caught.  We were told that she would pay cash to see certain doctors and would pay cash for any of the prescriptions that medicare of course would not cover because of the scripts she was getting from one doctor.  He said that is very common when someone is addicted.  

So she was offered rehab but she refused so they tried to wean her off of them, she had to sign a contract that she would only use one doctor and had to submit to urine testing.  Well a month later she tested positive for Heroin and the doctor dropped her as a patient immediately.  It is at that point the ME thinks she turned to Heroin, he explained to us that narcotic pills are very expensive on the street however heroin she could get a bag for $5-10 and it would typically give someone 15-20 "hits" (sorry just learning about all of this).  

I asked if when doing the autopsy were track marks found and he said yes on her feet and the arm that was cut open previously was so scarred that it could have easily been hid on that arm.  So that explained why she had one sock on and one off when they found her.  This has left both my husband and I feeling guilty that we should have pushed harder for her to move in with us so we could take care of her, we should have seriously addressed the self medication, everyone continues to tell us that would not have changed anything and we need to let go of that guilt.  

My husband and I are both full time students (husband is a journalism major) and both of us had one of our professors suggest for us to jointly work on a research paper about this because it could be cathartic for us.  So that is what first inspired me doing this, my husband and I are going to collaborate on this for our Senior Thesis and include a documentary type film.  I am doing an internship with the country solicitors office and we are both going to start volunteering at the local drug outreach center.  Thank you again for the information you have shared with me, I really appreciate it.

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kipling2448's profile pic

kipling2448 | (Level 3) Educator Emeritus

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You and your husband have obviously been through a great deal, and I hope the research project and work at the drug outreach facility both prove cathartic. Addiction is an enormously difficult problem, whether it involves drugs, alcohol, gambling, or any other addictive "vice." The challenges of recovery and sobriety never go away, as the desire for the element in question remains strong within those struggling with addiction. I'm a stranger whose opinion should be discounted, but I certainly concur with those around you who have urged you and your husband to resist the natural temptation to blame yourselves for the fate of your mother-in-law. Nobody can help somebody who doesn't want to be helped, and the challenges of addiction to substances like heroin makes that task virtually insurmountable. You did all you could, but you can't save somebody determined to self-destruct. 

Good luck on your project. 

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