Texas Medicine's January 2016 article "Pain Rules Are a Pain for Doctors" makes several exaggerated claims regarding the difficulty and triviality of vigilance in opiate prescribing. As the October 2015 Texas Medicine article "A True Antidote" notes, prescription opiates caused 16,235 deaths in the United States in 2013. Opiates are dangerous medications; we physicians have a responsibility to minimize the risks of opiate overdose and diversion.
The January article implies using the state's prescription drug monitoring program, Prescription Access in Texas (PAT), is onerous. On the contrary, if used regularly in one's opiate prescribing workflow, it becomes simple routine and no more difficult than checking lab work. Prescribing thyroid replacement includes routine monitoring. Prescribing antihypertensive drugs includes routine monitoring. Prescribing opiates also should include routine monitoring. Consider it a "background check" of a patient before prescribing a dangerous medication with high abuse potential.
PAT is not a perfect tool, but checking a patient's record has a high specificity for identifying patients who are doctor shopping or who have recently filled a prescription for opiates. Requirements for checking PAT will never stop pill mills or intentionally reckless prescribing but can help well-meaning physicians avoid prescribing opiates that would likely be misused or diverted.
Having previously worked in a northeastern state with an epidemic of prescription opiate abuse, I can assure you that you never want to discover that your own patient has been diverting opiates or, worse yet, has died of an overdose. Doing what we can to prevent these possibilities is an unavoidable professional obligation of opiate prescribing.
Christopher Chang, MD
March 2016 Texas Medicine Contents
Texas Medicine Main Page
Last Updated On
May 13, 2016