Shocking charges were filed yesterday in Boston against a doctor and nurse practitioner who allegedly caused painkiller overdose deaths in six patients; the patients reportedly paid them handsomely for the controlled substances. But the news begs the question: Just how common is it for doctors to feed their patients' drug habits?
Sadly, it's not as rare as it would seem, according to a study published Wednesday in the Journal of General Internal Medicine. That's not because doctors are acting as drug pushers but rather, the researchers found, they aren't taking the necessary precautions when prescribing addictive opiod painkillers like Vicodin, OxyContin, and Dilaudid.
Culling through medical records of more than 1,600 primary care patients treated with opiods for at least nine weeks during 2004 to 2008, the researchers found that only 8 percent had urine drug testing; among high-risk patients with previous drug abuse problems or mental disorders, the rate was still low: 24 percent. (The patients were all treated in practices that participated in the University of Pennsylvania health system.)
Only half of patients came in for follow-up doctor visits before getting a refill, and high-risk patients were no more likely to visit their doctors than low-risk ones. What's more, nearly a quarter of all patients (both high- and low-risk) received two or more early refills of the opiates -- often a sign of addiction.
"We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders," said Dr. Joanna Starrels, lead author of the study and a professor of internal medicine at Albert Einstein College of Medicine, in a statement. "We hope that these findings will call attention to this important safety concern."
-- Standardize a plan of care for all patients on long-term opioids, which includes urine drug testing.
-- Implement regular face-to-face office visits to evaluate a patient's response to opioids and whether there's evidence of misuse.
-- Stick to a previously agreed-upon refill schedule, and avoid early refills.
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