The LA Times ran a very interesting story a few days ago about deaths from overdose of narcotic pain medications. I strongly encourage readers of this blog to read the story, which discusses the issue from the perspectives of doctors, patients, and family members.
The story reports that a small number of Southern-California doctors wrote prescriptions that have killed a large number of patients. Over the past five years, 17% of the deaths related to prescription-drug overdose–298 people—were linked to only 0.1% of the area’s doctors. I was not surprised by the findings in the article, as I have read stories from other parts of the US reporting similar statistics.
There is a simple reason for the skewed numbers. Prescribing opioids for chronic pain is associated with risk of death by overdose. More and more doctors are avoiding that risk by refusing to treat chronic pain with opioid pain medication. That means that the few doctors who are willing to prescribe such medications are linked to a higher number of deaths from those medications.
Are the doctors who prescribe narcotic pain medications ‘bad doctors?’ Some doctors would claim that they are. I have described the doctors in a group called PROP, or Physicians for Responsible Opioid Prescribing, who take the position that almost all opioid treatment of chronic pain is inappropriate. I understand the point made by those physicians. Treating chronic pain using opioids carries significant risks. Complications, including death, are common. But I have met a number of patients who suffer from severe pain who take issue with doctors who tell them that they are better off without opioid pain medications. And I’ve noticed myself, from my own rare occasional injury, that it is one thing to talk about the proper treatment for someone else’s pain, and another thing when one’s self, or one’s loved one, suffers from pain.
The skewed numbers also demonstrate the problem with online doctor rating systems that report on the complication rate for one doctor vs. another. Across the spectrum of patients in need of surgery, for example, are healthier patients …