Treating pain has always been a complicated business for the medical field. And, perhaps, never more so than today.
“Our charge is to treat pain and suffering. We take an oath to do that. I think sometimes we are overzealous,” said Dr. Ira Stockwell, a longtime Westbrook physician.
Many Maine physicians are becoming more cautious about prescribing narcotic painkillers, often after realizing the pills are being used to feed a patient’s addiction.
“In the past, I made errors in that area,” Stockwell said. “And doctors of my generation, by the millions, have made errors in that area.”
But some also fear that an overreaction, or “opiophobia,” may be leaving many legitimate patients in real, chronic pain.
“There is no question we are undertreating pain,” said Dr. Eric Brown, a longtime physician in Bangor.
The introduction of OxyContin and other powerful narcotic pain relievers in the past 15 years accompanied a global push to treat pain that had historically gone unmedicated. The movement is credited with improving the lives of millions of cancer patients and other pain sufferers.
“Pain is horribly distracting and it makes you nonfunctional,” Brown said. “There’s some small percentage of patients that gets in trouble with pain medication.”
On the other hand, Brown said, “There are a huge amount of people out there doing great in their lives (because of the pills). They can go back to work. They get their lives back.”
Physicians, most of whom were never trained in pain treatment or addiction, say they are caught in the middle. They can face lawsuits for undertreating pain and professional discipline for overprescribing, they said.
Doctors say there are powerful industry incentives to continue prescribing narcotic painkillers, especially when patients ask for them.
Hospitals are increasingly rated according to patient satisfaction scores, and some hospitals pay doctors more money if their patients go away happy, and less if they do not.
Health insurers, meanwhile, routinely pay for prescriptions, but are less willing to pay for alternative approaches such as physical therapy or acupuncture.
Maine physicians, dentists and other prescribers wrote 1.2 million painkiller prescriptions in 2009, a 17 percent increase in five years, according to state data. In 2009, Maine doctors, dentists and other providers wrote prescriptions for 26 million tablets of hydrocodone, the active ingredient in Vicodin.
“They want to do the best thing for their patients, but the amount of prescriptions we’re giving people for their pain and anxiety is clearly making things worse and not better,” said Dr. Karen Simone, director of the Northern New England Poison Control Center.
No one knows what percentage of pain pills are used to get high or feed an addiction.
However, nearly 20 percent of opiate abusers say they get the drugs directly from doctors, according to national statistics. Nearly all the others get the pills indirectly from a friend or family member.
Isaac Malburg, a 37-year-old fisherman from the Rockland area, got a prescription for oxycodone after back surgery and gradually became addicted, going back to his doctor whenever his prescription ran out.
“There was a point when he said, ‘I can’t cover you any more.’ So I found a new doctor who could,” he said. “All I had to say was I was in pain.”
A growing number of doctors such as Stockwell and Brown now carefully screen pain patients to identify people who are most at-risk of addiction, such as those with family history of substance abuse.
They require pain patients to sign agreements, promising that they will not get drugs from other physicians or allow their pills to be taken by anyone else. Some doctors require random pill counts and urine tests to rule out abuse or interactions with other drugs.
Such precautions are now recommended by the licensing boards that oversee physicians, dentists and nurses.
Not all medical providers are devoting the same attention to the issue.
Fewer than half of Maine’s doctors and other prescribers have registered to use a seven-year-old statewide prescription database that allows them to monitor all the medications prescribed to their patients.
Some medical providers face discipline for being careless, or worse.
The Maine Board of Licensure in Medicine handles about two or three cases each year involving physicians who overprescribe drugs, said Randal Manning, executive director of the Maine Board of Licensure in Medicine. Most face suspension or other discipline, although some have their licenses revoked.
The board oversees 3,800 practicing doctors and physician assistants, and has revoked the licenses of five physicians in the past two years for either improperly prescribing drugs or abusing them personally, Manning said.
The board investigates complaints, but does not monitor doctors’ prescribing practices.
Manning said he believes doctors have been put in a difficult spot.
“Society decided we should be free of pain. And the expectation of society is, ‘We have the drugs, we want them to be used,’ ” he said.
The Maine Medical Association, a trade group that represents the state’s physicians, has been holding seminars around the state to help train doctors to be more vigilant about abuse and addiction.
Gordon Smith, the association’s executive vice president, warned more than 50 physicians in Bangor last month about the risk that pills could end up in the wrong hands, maybe even the hands of a bunch of middle-schoolers.
At the same time, he told the doctors, do not forget about Mainers who are suffering and the oath that you took to care for them.
“If pushed too far, the people who will actually be hurt are the people in chronic pain,” Smith said. “We all understand that.”
Staff Writer John Richardson can be contacted at 791-6324 or at:
jrichardson@pressherald.com
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