Thursday, August 29, 2013

Contrasts: Overdose Awareness Day and Doctors Who Still Don't Get It

Overdose Awareness Day is Saturday, August 31.  Events are scheduled all over the world to remember those who have fallen victim to drug overdoses and to try to prevent future human tragedy.  This is a day that should remind all of us that there are risks associated with opioids that must be dealt with in clinically responsible ways - or such human tragedy will find its way to your company, your claims organization, your desk. 

Contrast this forthcoming day or remembrance with a letter PRIUM received today from a treating physician with whom we were attempting to conduct a peer-to-peer conversation. 

Many of PRIUM's employees have inserted into the signature block of their emails the following quote of mine from a previous blog post "We must do everything we can to stop addiction before it starts, provide alternative non-pharmacological therapy whenever 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." 

Today, I was handed a letter from a treating physician that read, in part: "The goal of the PRIUM review process is to force medication changes by the treating physician, whether or not those changes are in the best interest of the patient or the best judgment of the treating physician.  This policy, exemplified by the inflammatory mission statement on PRIUM's correspondence [and he quotes the above statement]."

Other than being a poor excuse to avoid what would have otherwise been a helpful peer to peer conversation, this doctor completely misses the point of my statement.  Not to mention that I made those comments at the end of a post about a young man that had overdosed on Adderall - a drug prescribed by his physician despite his physician's awareness of his addiction. 

I want to be perfectly clear on this point:  the quote does NOT say "we must do everything we can to stop an opioid prescription before it starts..."  Rather, it says "we must do everything we can to stop addiction before it starts."  PRIUM physicians routinely suggest that opioid medications be continued for patients exhibiting documented functional improvement along with reduction of pain.  And we'll continue to do so. 

We simply see too many instances in which opioids are being prescribed, dispensed, and potentially consumed without any clinical evidence that the drugs have any positive impact on the patient's quality of life and ability to function. 

So... I'll take time to reflect on Overdose Awareness Day about what we're currently doing and all the work that still needs to be done to mitigate the risks of prescription drug misuse and abuse.  And I'll hope that doctors like the one that wrote this letter will have the courage to engage, to listen, to learn.

On Twitter @PRIUM1

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