Is Prince overdose a wake-up call for doctors?

How have we come to this opioid dependent point in America?

Since 1999, the amount of prescription opioids sold in the United States has nearly quadrupled, but there hasn't been a major change in the amount of pain that Americans report. The "amount" of pain is important because historically opioids have been reserved for those with moderate to severe pain resulting from circumstances such as surgery, injury/accident or cancer.

Every day I see patients who have been prescribed these medications -- but not for these (or similar) medical reasons. So why are health care providers writing so many opioid prescriptions? Have we overestimated the pain scales we were taught as medical students? Are we caving to pressures placed on us by drug-seeking patients to prescribe these medications? Are we simply not paying attention?

To answer these questions -- to solve this urgent problem -- we need to stop overestimating our patient's pain. We should be treating and assessing pain appropriately, in the way our medical training dictates.

We must be immune to pressures from patients who have been led on by the ubiquitous pharmaceutical ads in magazines, on the Internet and TV: Our first job as health care providers is to "do no harm."

I have been yelled and cursed at (even walked out on) by patients who become angry with me because I would not prescribe opioids when not appropriate. We cannot ignore that up to 1 in 4 patients on opioid therapy struggles with opioid addiction. Not paying attention to this simply isn't an option.

As an osteopathic family physician in an academic medical practice, my colleagues and I, like many other physicians, have taken a judicious approach to prescribing opioids.

My office has "controlled-substance agreements," for example, that a patient receiving opioids or other controlled substances must sign. These contracts require, among other things, that patients get their medications from only one pharmacy (pharmacy-hopping is not allowed), take their meds only as prescribed, return to the office for refills (meds cannot be refilled over the phone) and be subject to random drug screening. In addition, we also use the national Prescription Drug Monitoring Program, which allows providers to see which controlled medications patients have been prescribed by others.

We also regularly attend lectures and training on how to prescribe opioids and other controlled substances properly.

In short, we take this seriously.

Thankfully, many providers throughout the country are using these resources regularly to curb the inappropriate prescribing of opioid medications as well.

To be sure, the issue of opioid abuse and overdose is a complex, multifaceted issue, and the prescribing of opioids is just one aspect of this problem. Many doctors are prescribing these medications appropriately and many patients are taking these medications the right way. In fact, I often remind patients that opioid prescription medications are not bad -- they are quite useful in treating pain when used and prescribed appropriately.

And as a physician, my intention here is not to place the blame of opioid overdoses solely on health care providers. Rather, it's a wake-up call for us to take a step back and re-evaluate our prescribing practices. Not only is this appropriate, but it's simply "good medicine."

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