January 23, 2016

Patient satisfaction and the opioid epidemic

Everyone wants to be well treated by their doctor. And doctors want to treat their patients well. With Obamacare, patient ratings of their encounters has become mandated. For many employed physicians, patient ratings are important both for their pay and their continued employment. This all sounds good except that we are now caught in the middle of a public health crisis of death caused by prescription drug overdoses.
Since at 2012, we have known that there is a direct link between the prescribing of opioids and deaths from opioids, along with ER visits and admissions to treatment centers. Most of these deaths involve opioids and other drugs, most commonly benzodiazepines, Soma and alcohol. I do not believe they are suicide attempts, but rather too many sedating drugs taken at once. Often, some physical factor is changed, such as someone with bad lungs getting an infection or someone who is deconditioned being physically active, as in moving. The end result is death. These deaths are preventable. Their occurrence is a public health crisis.
Physicians are becoming aware of these problems. Medical Boards are issuing new guidelines. State prescription drug monitoring programs, CURES in California, are becoming more robust. Soma is being taken off formularies. The prescribing of opioids and benzodiazepines is being identified a poor practice. Despite these changes, according to the CDC, the number of opioid deaths continues to rise.
Further, the number of deaths in the ER from medications is overwhelming from prescription drugs. Heroin and cocaine combined do not equal the number of deaths from prescription drugs.
Why are the number of deaths going up? Most opioid prescriptions are from primary care physicians. Firstly, they are not geared up to do the tasks necessary to safely prescribe opioids, such as do CURES reports, stratify for risk, do urine drug screens and maintain patient agreements. More importantly, however, they are graded upon patient satisfaction. People who want opioids get angry when they don’t get the opioid, or benzos or Soma. Bad reviews come in. It also takes time in a busy practice to deal with drug seeking patients. Who needs the drama?
The result is that the effort ensure that patients are well treated has the unintended consequence of worsening the prescription drug epidemic.
We need a meeting of all involved parties, physicians, health systems, our medical planners and the public to discuss how to maintain patient satisfaction without enabling drug abusers and worsening the prescription drug death problem. Until we get a handle on this problem, there will be needless, preventable deaths. Obamacare should not be contributing to a public health problem.