- - Wednesday, September 5, 2018

America is in the midst of one of the worst drug epidemics in history. Unlike past crises, this one was fueled not just by illegal drugs peddled on the streets, but by the over-prescription of legal painkillers that sadly led many patients into a cycle of dependency and addiction.

While there are many steps in the process of an individual getting a prescription drug, it ultimately starts with a doctor. When examining the causes of the opioid crisis, it’s important for the medical community to reflect upon one important question: Would the crisis today have been as bad if doctors were more responsible with how and when painkillers were prescribed?

In many ways the opioid crisis started in the examination rooms of doctors offices. The relatively recent emergence of pain as a fifth vital sign and the desire to alleviate pain led to a marked rise in opioid prescriptions. Due to a poor understanding of the drugs they were prescribing, some physicians used painkillers meant to treat acute pain as chronic pain treatment, thus providing high doses of opioid painkillers to patients over a long term.

Other physicians, either caving to pressure from patients or for expediency purposes, wrote opioid prescriptions when alternative treatments or physical therapy may have been more effective ways to mitigate pain. Either way, the outcome was the same. Patients who could have otherwise received more effective treatment were instead provided unnecessary opioid prescriptions.

A growing number of lawsuits, filed by governmental bodies as well as class-action and plaintiffs’ lawyers, are seeking punitive damages for alleged misconduct that caused the opioid crisis. Nearly every part of the health care supply chain — from the drug companies that manufactured the opioids to the pharmacies that dispensed the prescriptions, and everyone in between — is being sued. Yet for unexplained reasons, one vital player in the whole process has been left out of the proceedings. Physicians, who misprescribed opioids should be held accountable, just like anyone else.

Sadly, some physicians acted nefariously when putting opioid prescriptions on the street, motivated by greed and the allurement of an easy payday. Pain clinics, many of them dubbed “pill mills,” served as a one-stop shop for opioid addicts to receive their fix. Often an all-cash business, doctors would trade prescriptions for money that could often be filled under the same roof. The temptation of personal benefits also affected other doctors’ prescription habits.

Earlier this year, five doctors in New York City were arrested for participating in a kickback scheme where so-called speaking fees were provided from pharmaceutical companies in exchange for writing millions of dollars’ worth of painkiller prescriptions. If the goal is to get to the initial cause of the opioid crisis in order to solve it, prosecutors need to do the hard work of finding these individual providers who acted illegally and hold them accountable as well.

While it’s easy to say that the entire medical community must be held to the highest standards, the reality is doctors must police themselves when it comes to prescribing opioids. Patients trust their personal doctors to look out for their best interests when recommending a course of treatment. Insurance companies and distributors, meanwhile, do not and should not have the ability to question prescriptions to patients. They were not involved in the testing and diagnosis that led to this course of treatment, only doctors were. Doctors, therefore, must seek to provide alternative treatments for pain when available and avoid the “easy fix” of prescribing opioids.

Our country suffers from the effects of overprescribing in many ways. Too many antibiotics has led to a rash of drug-resistant infections. Many patients prescribed antidepressants have been found to have no medical need for the treatment, unnecessarily risking a variety of adverse side effects. And now a glut of opioids has led to an addiction and overdose crisis in our country. Much as the medical community has come together to tackle other overprescription issues, doctors should take responsibility for finding solutions to the opioid crisis and make changes in their standards to fix it.

• Dr. Paul Broun is a family physician and former congressman from Georgia’s 10th District.

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