The Narcotic Prescription Epidemic–Part IV

To buttress my assertion that for the most part until recently physicians have been ‘babes in the woods’ as far as addictions are concerned and this has lamentably reflected in their lax prescription practices, I would offer two developments. In 2000-2002 when buprenorphine started to move into the prescription market as the newest and best narcotic antagonist, that could be used to detox someone in literally less than two weeks, and/or be used for intermediate daily maintenance through private physician office prescription instead of having to attend a five day a week ‘public’ methadone federally regulated dispensing clinic. I was I think the 4th MD in North Carolina trained now 14 years ago to do this work as one had to be trained and certified (and still do). I welcomed this tool and a real improvement and evolutionary step in our treatment armamentarium of battling opiate addiction. But within several years studies began emerging from multiple monitoring groups that four out of every five physicians who were certified to do this kind of work, found out they intensely disliked working with addicts and gave up their special DEA licenses to be able to utilize buprenorphine and simply stopped working with addicts. Addicts as a group and most of them individuals are a real hassle to deal with. They do not play by the rules of the treatment relationship that almost all MDs expect and are comfortable within. Addicts can be some of the most difficult, ornery, demanding, dishonest, patience exhausting individuals any practitioner deals with. And buprenorphine in its earlier forms began to be massively diverted as well…

The second observation I would put forward in supporting the assertion that MDs by and large have been inept at best in managing the difficult shoals of prescribing narcotics, is the fact that for the better part of this past decade or so, scads of continuing medical education courses have emerged from many many medical educational organizations, state medical boards, board certification organizations and most medical schools and “area medical health educations centers” organizations almost no civilian has heard of. The latter are everywhere in the country and legally mandated to offer medical, nursing, pharmacy, almost any kind of healthcare advanced or refresher training one can imagine. One nearby to where I practice and live in western North Carolina is “MAHEC,” Mountain Area Health Education Center. The point is all these bodies have been offering free and for fee courses on the many aspects of opioid prescribing, management and monitoring, in a national effort to help curb this prescription drug epidemic. {By the way, it might be wise to inqiure of your health care provider what her/his intentions are in this area]. It is coming for us all…I myself am taking my umpteenth course in this area, a four part online excellent course since I see and treat addicts routinely in my present setting of a state psychiatric hospital.

The third argument I offer that MDs must have re-training or better training in the use of narcotics, is that for the last several years the DEA (Drug Enforcement Administration) has been working on implementing and moving toward mandatory training courses and certification in the use of narcotics by all MDs for controlled drugs. That is likely to include such controlled drugs beyond opiates such as the potentially dependency producing anxiety medications such as Xanax, Valium, Librium, Klonopin and Ativan; sedatives such as Ambien, Halcion, Restoril; and the stimulant drugs used in the treatment of ADHD (attention deficit hyperactivity disorder) which affect perhaps 5-9% of all school children. I cannot tell how many MD colleagues and MDs I do not know but have talked this over with at medical education meetings, who have declared with palpable relief that when this measure becomes as it were, “medical law,” they will decline to take the training and be shed of dealing with these drugs and with addicts. They realize that they will be leaving their ADHD patients and cancer pain patients with no options within their own practices, but it cannot be overestimated how many physicians, as the ‘tv newstory’ move of some 20 years ago stated in its famous line: “I’s sick and tired of it and I’m not going to take it anymore!” From my perspective this is going to be a real mini-medical crisis of delivery of care.

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