In 2011 a group of physicians descended on Capitol Hill to ask congress to help them fight prescription drug abuse. How? Finally require all health care professionals get real training in prescribing addictive drugs, recognizing signs of addiction, and identifying problematic patterns of use.

Most physicians receive little or no training regarding substance abuse and the use of controlled substances that have the potential for addiction. While there are many doctors who prescribe these powerful drugs responsibly, and these drugs are often critically important when used as intended (usually very short-term use or on an as-needed basis), better education will help them recognize drug-seeking behavior and train them to evaluate and refer these patients to treatment the same way they do when they see high blood sugar or blood pressure.

27 Comments to
Why Do Doctors Prescribe Addictive Drugs To Known Addicts?

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  1. I think what readers need to know is that there is a population of addicts out there that are, for no other term I can think of applying here, ruthless in their pursuit to get prescription drugs for reasons that boil down to one agenda: relatively easy access to psychotropics that they can falsely justify if caught are not a problem or risk.

    I have been continuously outspoken for at least a decade now for getting rid of at least some of the benzos still available in pharmacies that are as much a detriment as any benefit to legitimate cases of anxiety that need controlled substance intervention. And the primary candidates are in order: diazepam (Valium), alprazolam (xanax), and to a lesser but cautious degree for clonazepam (Klonopin) as well. The rising percentage of people who are coming in to community mental health and private practice office settings just becoming bold and brash in demanding these meds and copping a lame attitude when rebuked is getting old and disruptive to all who are appropriately setting limits.

    It is unfortunate we have to endure the death of another celebrity who once had promise and such talent to responsibly entertain us in the general culture. But, it is a gray zone when people slip and become dependent and then impaired, thus tarnishing their prior history of benefits to others. Here is the question that has no right answer for all, but does for each individual situation applied to: can one wrong act negate the many right ones that precede the mistake or commission? Only those involved in said scenario can answer that.

    Maybe the silver lining to Whitney Houston’s death is this: it is time to wise up and see that prescription drug abuse is as dangerous, disruptive, and impairing as heroin, cocaine, and alcohol. And, it is time for physicians as a sizeable majority to finally say NO to requests for prescription drugs that have no legitimate basis.

    Start with this: you want a controlled 2 prescription or Xanax/Valium, then take a drug test at the start and any random request in the future without any argument. And, after the ONE strike for asking for a refill prior to a script completed as expected, prepare for being denied the early refill, if not again denied getting one when due later.

    Hey colleagues, I will take the risk in assuming up front the doctor(s) who wrote scripts for Ms Houston are most likely not overt villians, but the mob will try to lynch them viciously because America needs a scapegoat. And oh how so sadly people wearing white coats are now looking behind and seeing a target on their backsides!!!

    • You forgot Ativan. I was prescribed it five years ago this Spring. By Psych Doc, a long with Lexapro. I’m still on both. And very addicted to the Ativan. It was never prescribed for PRN. It was to be taken on a shedule. “To stop anxiety attacks before they start” just wanted to share that. Would I like to be off them. Yes. But I was told by my Doctor I will probabley be on them for the rest of my life. Taylor in Ohio

      • I’ve come back to see and read these new posts. Sounds like everyone has an opinion. Maybe some docs don’t get it, but there are truly people out there who need help, meds, therapy whatever works for them. I am not now or have ever been a drug seeker. I never even heard of Ativan or Lexapro,untill they were prescribed to me. And silly me, addiction never crossed my mind, I trusted my Doctor in that he knew what was the best way to treat me. Such a slippery slope, people with a mental disorder need help, doctor wants to help, but in the end maybe we are both plain out screwed. Before all psych drugs are gone, or illegal or whatever, could someone find a cure for mental illnesses first? Thanks. Peace. Taylor

    • I agree to a point Dr. Hassman, there are addicts that are very good in tricking MD’s into prescribing medications they do not really need, but I agree with the article saying there needs to be better abuse education to combat this. What is on the pharmacy shelves should not matter if prescribing providers are better educated for one, and second, quit using the revolving door method of practicing. I can go doctor shopping with a list of symptoms I have gotten off the internet and get scripts if I was a good con artist because doctors do not take the time they need with a patient, it is get them in, get them out, and as long as the answer questions correctly then all is good.

      I have lower back problems, and never had a problem getting a script for muscle relaxers, based on my original injury, and past medical history when I changed doctors. The doctor I go to now is not a revolving door doctor, and questioned me about the problem, treatment I have failed, examined me, and shot x-rays. He is also the first doctor that required me to come for follow ups for refills (My refills expire due to time since my last bottle took me a year to use up), and he is the first doctor to ask me if I have ever been treated for addictions. He is also the first doctor to sit down and talk to me about my back problems and go over the x-ray with me, and talk to me about managing the problem.

      As long as we have doctors that will shake your hand, slap you on the back, and show you to the door we will always have con artists taking advantage of them. Abuse education is important, and the time a doctor spends with a patient is equally important.

    • Dr. Hassman,
      I agree with you completely however a person would have to be blind not recognize that Whitney Houston was a raging addict. She openly used abused alcohol and other drugs and I know that I do not have to tell you that alcohol and benzo’s do not mix. I don’t think these doctors are bad guys but I do think their prescription writing habits need to be examined. I am a Licensed Chemical Dependency Counselor and in my profession the sanctions that are placed on dangerous and unethical behavior can cost us our life’s work, position and money. I cannot tell you how many clients I have treated for prescription drug addiction only to have them go back to their doctor and get another prescription. I am required to spend a minimum of 45 minutes with each client; doctors spend an average of 3 to 5 minutes and it takes about the same amount of time to score illegal drugs on a street corner from a car window. If patients come in requesting life threatening prescription drugs the ethical doctor would require them to have a drug and alcohol assessment by an addictions professional, if the patient really needs the medication the he/she will comply with the assessment, UDS and ongoing responsible medication taking behavior. I think doctors need to be required to take classes that would help them to understand addiction and be required to maintain CEU hours as well, doctors are not substance abuse professionals anymore then Judges are doctors and look how many of them try to dispense/ enforce medical advice.

    • my wife was an alcoholic and was prescribed xanax and clonazapam by her psychiatrist I told him on several occasions that I thought this was a bad idea and would end in tragedy if he kept giving her these drugs,but she was also prescribed antabuse by him also.All her pills were locked in a safe only I had the combination to.I would give her the pills she needed for the day each morning before I went to work.I came home from work at the end of the day and found her dead on the floor by the side of the bed, she had somehow gotten a hold of some alcohol.The worst part was when I contacted her doctor to tell him what had happened and he told me (even though he said it was a violation of patient confidentiality)he asked her one time what she does when she wants to drink while taking the antabuse and knowing she will get violently ill,she told him when she feels she is getting the urge to drink she won’t take her antabuse for three or four days and then drink.What I don’t understand is why he would tell me this after she’s gone.Had he told me this while she was alive I would have made her take her antabuse while I watched her,if she refused I would not have given her the xanax and clonazapam,she would still be alive and not dead at the age of 43 with 3 daughters left motherless

  2. this article is exactly the argument my daughter uses for NOT taking medication for her mental illness.so sad

    • Actually that isn’t the same argument. I would argue that people who need medications for mental illness (such as bipolar disorder, clinical depression, schizophrenia etc) and do not take them are at risk for abusing addictive, mood-altering drugs. Many of the people who become addicted to anti-anxiety drugs, pain pills etc are self-medicating because they have either not been properly treated/diagnosed so they can be given an appropriate (usually nonaddictive) medication.

      • I think “mom” was talking about the general problem of doctors not prescribing medications because they don’t want the patient to become addicted. It is the same argument, or at least very similar. The roles are just reversed: the patient is internalizing the perception that the physician normally has, which is a reluctance to provide medication to a patient because of the risk of addiction.

        More generally, this article misses or ignores a very important point aspect. I’m not surprised though, and it very mush highlights my point about how this is not taken seriously.

        I don’t deny that there is a problem, and this article spells out that problem very well.

        But the whole story is far from told.

        Physicians are human. Humans make mistakes. Humans have biases and perspectives that can blind them towards either reality or other perspectives that can give insight, provide more information, and help them make better decisions.
        Many humans are also preoccupied with being right. Physicians make this trait dangerous (and many – not all – but a sizeable portion of physicians), because with it comes a false sense of surety, a belief that how they see the world is the way the world is. Hunches turn into facts, and when some doctors know something, they will no longer look for or consider evidence to the contrary.

        This is a terrible phenomenon, and one that I have seen over and over in hundreds of settings (professionally, not personally; I have never needed nor taken prescription pain medications): Doctors making decisions that cause their patients to suffer needlessly by not addressing or treating what is in fact real pain.
        Pain is uncomfortable. It can be severe. It is a heartbreaking. It hurts. And guess what? People who are in pain seek relief. Drug-seeking is a normal, expected, and prudent reaction to pain. It should not be labeled a negative behavior outright. Duh.

        I’ll close with an analogy. Now this may not be exactly how the system works, but the concept is instructive: in a nation where you are innocent until proven guilty, procedures designed to protect innocent people from being punished will inevitably lead to real criminals escaping justice. We would rather see 5 guilty people not punished than send 1 innocent person to jail.
        Yes, powerful drugs will lead to addiction in some people, and some people will try to manipulate the system to get more of these drugs.
        But doctors need to accept that occasionally they will be duped into doing this, or that by writing a prescription they will introduce some patients to a drug that leads to addiction. By accepting this notion, they will be less likely to cause suffering in a patient who desperately requires some relief for pain which is with them every waking moment.
        A doctor who thinks he knows is patient’s motivations – especially when the patient states otherwise – is dangerous, harmful, and causes unneeded suffering.

        I don’t like the idea of catching every criminal if that means many innocent people waste their lives in jail.

  3. I used to do the occasional lecture to frosh med students at Georgetown, and would remind that even though they wanted the patient to see them as concerned, competent and professional, if that patient was a drug addict, there was this big flashing neon sign over the doc’s head reading, “All Night Pharmacy! We Never Close!” And no matter what the physician said or did, from the patient’s perspective, that sign never ever stopped flashing.

    I think the message got through. They were first years. They don’t stop listening until third year.

  4. My AA Sponsor told me early on that it was “my job” to educate “my doctor” about “my alcoholism and addiction”. Only another recovered alcoholic/addict can understand this disease. I don’t care how many books they’ve read or gone to school, degree or not. Doctors will never understand alcoholism and addiction.

    Thing I find most interesting is the huge numbers of doctors that they themselves are addicted. Maybe signing the script pad is more psychological projection on part of the doctor. Food for thought.

    All AA (don’t know about the rational recovery whatever people) but we know better than to take drugs from docs. That game has been played out for years by good AA’s all over. We know it. LOL

    • Sue, I am an AA member, as well, sober just over 30 years. Please read the appendix in Living Sober: “No AA member plays doctor.” I have seen suicides amongst AA’ers who were told that they were “not sober” if they took medications for mental illness. They stopped their meds and ate their guns (in one case, a wonderful woman I knew walked into a lake and kept walking until she drowned). I know people, sober decades in AA, with severe, intransigent pain who take narcotic analgesics *as prescribed*, or antidepressants, et al. They don’t mention this to others in the AA community for fear of judgment and isolation (AA “excommunication”).
      One size does not fit all. After 30 years, two months and 21 days of hard-won recovery, I feel increasingly uncomfortable with people who insist that the program of recovery can only be worked one way – their way. But I keep coming back because AA is my home, because newcomers need to see that this works, because I need to “pass it on.”
      If we become overly rigid, however, we will break. Bill W. knew: the biggest threat to AA survival is its own members.

  5. Reading the comments here and at other sites about this issue and similar topics regarding the overprescription of controlled substances, it is time to see people who write scripts without much concern for consequences start to see said consequences.

    Personally, as I said above, benzos should become category 3, or even 2 substances, especially xanax and valium the 2 designation. Yeah, how many psychiatrists are going to write the quantity of benzo scripts if they get the attention of what opiates get?

    But, we are a culture and species that has to touch the proverbial stove at least a few times before figuring out what a burn means, eh?

  6. Sue, I’m sure your comments are well intentioned, but I’m so disgusted with narrow minded AA/NA rhetoric. I urge you to put down the slogans and the 12 steps. I attended 92 NA mtgs; and I’ve never felt more hopeless or unempowered.

    Look into alternative treatment methods, read the reports on the effectiveness of AA/NA, think for yourself, be proud, be brave, stop labeling yourself and admitting personal defeat at every meeting.

    Check out SMART, CBT, Rational Recovery, Harm Reduction, motitvational interviewing, etc…

    The comorbidity of substance abuse and mental illness is real, and AA/NA should be held responsible for criminal negligence. I’ve witnessed many people that were getting the therapy/meds needed to treat the underlying cause(s) of their addiction; who were bullied both “in the rooms” and by their sponsors to stop taking their meds and going to their Drs. These people that were told they were “not really sober” and not allowed to share in meetings, because they were taking meds prescribed by their psychiatrist for serious mental illnesses.

    Do I need to tell you what the outcome is in these situations…

    • I would be careful about throwing out the baby with the bathwater. For some, the structure of 12-step groups is very effective. I am always wary of statistics. Even if AA only resulted in a 5% success rate, is that not meaningful for those 5% who do succeed? Look at other medical diseases with low treatment success rates – people don’t simply say they won’t bother trying. They hope they are in that percentage who do improve or go into remission.

      That said, anyone in a 12-step group who is advising other members on their mental health treatment (especially those with clinical depression, bipolar disorder, or schizophrenia) is way out of their depth – this highly inappropriate “counseling” can have tragic results. They usually do not understand the difference between addictive drugs used to get high and psychiatric drugs used to stabilize mood. It is possible to steer clear of these types of people, but like all organizations there will be zealots who misinterpret or ignore the traditions.

      • AA has literature that specifically advises members not to assume the mantle of resident expert on therapeutic medications, including anecdotal warnings about what might happen as a result of such “well-intentioned” interference. I sponsor a woman who is reluctant to attend AA meetings because she is being treated with opiates for chronic pain. She has had other members tell her they question her sobriety. It pisses me off, but I can’t shake these folks’ marbles into line, so I just try to give this woman all the support I can and hope for the best. It’s always a pain when people don’t follow the leading principles of their own organizations, but such is human nature.

  7. Dr. Sack what a great article. I believe that whether a patient is med seeking or not prescribing an addict a narcotic is a setup for disaster. Thanks so much for this article and thanks to all for your great comments.

  8. well, there is no easy answer. How far do you go to help and at what cost? How much is enough time to assess and treat, talk or medical therpy? You can do only what you think is the best. The person is responsible for their own soberity. It is interesting how we impose our own thoughts and beliefs on others. It is always about self.

  9. I have been on the search for a good doctor for years. All of them seem to just give me a script to test and see if it works. After years of being a lab rat, a friend let me try her oxycodone. It was great! I was motivated, has lots of energy, could concentrate. Little did I know that I would eventually get addicted. Not one doctor has tested me for any diseases our disorders. They just go off what I say. I am now prescribed crazy amounts of drugs that I can honestly say are ruining my life. I’m so addicted that I do my prescribed medication in two weeks and spend all my money buying off the street for the next two weeks. My doctor doesn’t care about me. I found out that every patient there gets the same exact medication and amount I do and you can tell there is nothing wrong with a majority of them. I listen to people in the waiting room making calls to people who will buy there scripts when they get thorn. I told my doctor about it and he didn’t even care. I told him I could point out the people in the room with me who were selling and
    he said don’t worry about it. Thing is…I’ve been to just about all pain management docs in my area and they are all the same. I would rather live in pain than be dependent on these drugs. Tried to get help and my options were suboxone and methadone. What? More addicting drugs to cure an addiction. How does that work?

    • As a consumer and a citizen, you have the right to report this kind of crappy practice to the medical board. They won’t know what’s going on until they are told by someone.

    • Whoa–I just had a second look at your comment, and a couple of things hit me. First of all, I’m sorry, but why did you take a powerful prescription medication from a friend? And second, how can you “tell there’s nothing wrong with” anyone else by looking at them? As a chronic pain sufferer myself, I don’t have a lot of obvious outward signs that say “OUCH SHIT I HURT ALL OVER!!” The only ones I’d be worried about are the ones you actually heard setting up sales.

  10. As someone who binges often and has seperate mental health issues, i think that gps are a joke! They throw these things at you. Ill admit i was abuseing benzos that made me get the taste for them. I used them as a crutch but cud limit. This was when i bought them off the street. I couldnt get any so i went to my gp and he had no problem to give them to me, coz he knew i had tried all other routes for my mental health so he felt it was ok. But here i am down the line a year and a half later and im still getting perscribed and there has been NO talk off addiction or where i could end up because of them. I know im dependant (not physically) and my dr has said nowt to me!

    The question it boils down to is:
    Should the docs be educated on how to deal with this? Should the docs assess your (addictive) condition? Or does the potential consequences fall down on me and my knowledge of myself?

    One thing i read here was about docs and drug testing before any potential problamatic drug should be administered, i think this is not a bad idea at all. But b4 you jump the gun, some docs dont even ask first about your (addictive) situation. Like i said, i have never been spoken to about its effects and dangers…..it is only because i have already acumilated knowledge that i know where im headed…..

  11. I moved from Florida after spending 4 years there before moving back to Kokomo, In. While in Florida, I became introduced to the “pill mill” procedures taking place on a wide scale there.
    I had back pain and got an MRI and took it in to a doctor (pain Management). After one visite, I was prescribed 180 – 30 mg.Roxycodone, 90 – 15 mg.
    Roxycodone and 30 – 2 mg. Xanax every month. Never having taken anything stronger than ibuprofen, I became addicted. “NO more Pain”. I ran out of my script because i increased the dosage and the next thing you know I was sicker than I’ve ever been. My point is, YES, it is too easy to get prescribed pain killers to the detriment of individuals and their families who have to endure the psyche of an addict.

  12. Great article. My husband, father of 4 children was found dead in bed by our son. I expected it. He was an addict. What I didn’t expect was to be shut out of his treatment plan. His doctor gave him morphine patches and many other drugs. I read about them on his autopsy report. My husband would verbally abuse his doctor, the pharmacist, nurses and doctors at emergency often until he got what he wanted. There are many healthy professionals whom I want to hold accountable but his end was totally predictable because his brain was diseased.

  13. I don’t why addictive drugs are prescribed for patients who have addictive personalities. There are so many common sense ways to deal with stress, such as meditation, prayer, connection with your family and community, and exericise. None are addictive nor do they have any negative side effects.
    Author Barbara Altman

  14. I’m searching for answers and found this discussion. My son is a wounded warrior (he stepped on an IED in Afghanistan). I just found out that he’s been addicted to his pain meds (Oxycodone)for two years. He quit going to the VA and was buying them off the street because he knew if he got them for free he would never stop. He’s trying to get clean on his own (I can’t convince him otherwise and am waiting for the other shoe to drop). I have so many questions but I’ll ask just two for now – What is the likelyhood of him being successful trying to stay clean on his own? And what happens when he needs pain meds for legitimate pain? I’m sure he’ll need more surgeries in the future.

  15. My mom has been on Xanax for a decade. She is a shell of her former self. Xanax likely causes permanent brain damage, but this fact is suppressed by big pharma. A person taking Xanax for a number of years is likely to become psychotic, aggressive, amnesiac, etc. It’s like being around a violent evil zombie.

    Long story short I found out who her quack doctor was and wrote him a nice certified letter threatening legal action if he continued to enable my mother’s addiction by prescribing Xanax. It is within his discretion whom he treats, and I’m doubting he will find continuing to treat my mother worth the expense or protracted litigation.

    If you have a loved one who is abusing benzo’s find the doctor and promise legal action. Most doctors are going to want to risk getting sued, even if they feel they will prevail.

  16. First, it’s not all the doctors fault. You’ve no clue how many druggies have seen or lied to. Second- A lot of these people who are dying are KNOWINGLY ingesting thing they are well aware are narcotics and addictive.
    Third- people who stand and judge because people need pain meds have never felt the icy grip of being in such terrible pain and there’s nothing to be done anymore…..Thanks to the judges of the world. Do you know how to function when your head is splitting open, you’re vomiting until you’re half unconscious and having seizures. All of that from a silly old headache, ones I have every day of my life and live in constant fear of the pain climbing the walls again especially when help is in such short demand thanks to the goody-two-shoes that forget about people who are really suffering and lump the actual junkies in with us. Is that because in some mad idea of superiority you think you’re all better. Shame on all who think this way, shame on the government officials who take away the right to live, function in life and leave only the prospect of a lifetime of horrible pain, doctors who give little help, and others that automatically label you a drug addict. So many need help yet met with harsh, unsympathetic words they wander off despondent, lost, nothing to look forward to, no help only judgement; right there, that moment is when they fall. They can no longer face day after day of this painful hell and the sympathetic people, who love you and you love them, have no power to help. Now is when the commit suicide somehow. Meds didn’t do it, the government in our personal business, yet they don’t know a thing about us. And then there are those who can take an aspirin, to radio,or ibuprofen…Well goody for you. Trust me we all wish it were that easier. Watch who you sling your derogatory words at because I guarantee you’re throwing them the wrong way; just like the government.

  17. I STILL DON’T THINK THE DOCTOR ARE DOING IT . IT’S THE Physician Assistant & NursePA are these ones that are prescribing addictive medicine. Once you told them it not working they try to wean u off. But it doesn’t work. Then they put u right back on it. Then they say u are taking to much they put the blame on the person. Most time you don’t get to see Doctor that the problem. They put u with PA I very not happy with a Psychological doct about my mother problem when we told them several times finally she went to a Detox place but now they blaming her when they the one prescribed they need to get rid of the two most addictive medicine out there

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