Michael Gavin, Chief Strategy Officer of PRIUM, focuses on healthcare issues facing risk managers in the workers' compensation space and beyond. He places particular emphasis on the over-utilization of prescription drugs in the treatment of injured workers.
Monday, February 4, 2013
Another Sad Story: Prescription Therapy Gone Awry
The front page of the Sunday New York Times yesterday featured
the sad story of Richard Fee, a bright, talented baseball player who, as the
title of the article states, Drowned in a Stream of Prescriptions.His particular addiction was Adderall, an
amphetamine-based medication used for the treatment of ADHD, a diagnosis which
was questionable at best in Richard’s case.
The story resonated with me, though, because of its implied indictment
of our collective approach to any form of care delivery that might take more
than a five minute office visit or a thirty minute trip to the operating room.In particular, I saw themes throughout the
article indicative of our culture of overtreatment and overreliance on
prescription medication.We’re dealing
with more than just an opioid problem.We’re dealing with more than just a chronic pain problem.The fundamental model of care delivery is broken.
Below, I’ve taken several quotes from the Times article and simply removed the name of the drug and the diagnoses.Ask
yourself: How many injured workers do you know that fit the descriptions below?
“Through the remainder of 2010, in appointments with Dr.
Ellison that usually lasted under five minutes, Richard returned for refills… Records indicate that he received only what
was consistently coded as ‘pharmacological management’ – the official term for
quick appraisals of medication effects – and none of the more conventional
talk-based therapy that experts generally consider an important component… of
“His [prescriptions] were always for the fast-acting
variety, rather than the extended-release formula that is less prone to abuse.”
“Virginia is one of 43 states with a formal Prescription
Drug Monitoring Program… Although pharmacies are required to enter all
prescriptions for controlled substances into the system, Virginia law does not require doctors to consult it.”
“’The doctor wouldn’t
give me anything that’s bad for me,’ Mr. Fee recalled his son saying… ‘I’m
not buying it on the street corner.’”
“He had it in his mind that because it came from a doctor, it was OK.”
DeAnsin Parker, a clinical neuropsychologist in New York: “Diagnoses
are made just this quickly, and medication is filled just this quickly.And the lack of therapy is really sad.Doctors
are saying, ‘Just take the meds and see if they help.’”
Richard Fee eventually took his own life, unable to deal
with his addiction and its consequences.
We must do everything we can to stop addiction before it
starts, provide alternative non-pharmacological therapy wherever we can, and
help safely wean those already addicted to medications that are doing more harm
than good.This won’t be easy and it won’t
be cheap.But we have to do it anyway.