Prescribing opioids (March 2016)

Willie J. Pettiway

doi:10.3949/ccjm.83c.08001

TO THE EDITOR: As a primary care physician who has practiced for 31 years, I have a few concerns about the article “Prescribing opioids in primary care: Safely starting, monitoring, and stopping” by Drs. Daniel Tobin, Rebecca Andrews, and William Becker in your March 2016 issue.

Prescribing narcotics and other controlled medications has become a hot topic with legal implications. Many physicians have lost their license, and some have lost their freedom as well.

The article notes that primary care physicians provide most of the care for chronic pain but implies that we don’t know what we are doing. Although we might not have completed a residency in the management of chronic pain, we were required to attend a graduate medical school and to complete residency programs. We are also required to read the medical literature and keep up with our CME requirements. We too strive to keep up with and practice the latest cutting-edge medicine. And we have experience. After seeing thousands of patients and writing millions of prescriptions, I think I do know something about whether or not a medicine is safe, effective, and cost-effective. I have encountered quite a few patients with pain, and not one of them has overdosed by taking the medications as prescribed.

Most of what is being said and published about pain medication focuses on the epidemic of young people who are getting pain medications (prescription narcotics) and street narcotics (heroin) illegally. Directly, it has nothing to do with conscientious physicians prescribing narcotics for pain, but indirectly, it has to do with all adults in society. We are allowing our young people to be destroyed by drugs and by a lack of proper discipline in our homes that spills over into society. Where are our children getting these drugs, and who is bringing them into our neighborhoods? The practice of medicine is not the primary problem. I am for scientific, conscientious regulations concerning controlled substances. Medicine needs to inform all doctors about the changing laws surrounding the prescribing of controlled substances.

Cigarettes and alcohol are sold on every corner, and places selling marijuana are popping up everywhere. The former two drugs are harming and killing more young people than all the illegal drugs combined, and marijuana is fast approaching number three. I feel we need to stop picking on the medical profession and stop trying to blame it for all the woes that our young people are encountering every day. The reality is that legal and illegal drugs are not going to go away. We need to love our children more and better prepare them while in our homes to deal with the evils in our society.