Pain (not Thomas)

The government announced yesterday that it will seek to strengthen oversight of the prescription of certain narcotic painkillers. There is concern that patients are illegitimately obtaining and then abusing such medications as OxyContin, fentanyl and Dilaudid. Under the new proposal, physicians would be required to undergo training before being permitted to prescribe these medications. The hope would be that doctors could better identify "drug seekers" and reserve narcotics for patients that actually need them.

Whether or not this proposal will be implemented is unclear, as it would likely require Congressional action before taking effect. Also uncertain is whether or not this would even be a good idea. Drug seekers (people who fake or exaggerate pain to receive strong analgesics that they then use recreationally or sell) have been around as long as pain medication itself, and while it's certainly a dangerous practice that should be curtailed, there are risks inherent in doing so.

Not the least of these is the potential for "false negatives," patients who are in legitimate pain but are denied pain medicine for fear they're faking it. I read an interesting article a little while ago (which I'm unfortunately unable to locate at the moment) in which a physician discussed the relative merit of combating drug seeking versus the elevated risk of denying patients the medicine they need. That particular physician believed that nothing justified withholding needed treatment from a patient, and if the cost of avoiding that was rules lax enough to avoid false negatives but which also allow more drug seekers to achieve their ends, then so be it.

That's not to say that the new proposal would necessarily have this effect. Indeed, if the training were effective, physicians might be better able to identify those patients who are truly in pain (reducing false negatives) while also better weeding out those patients who are simply looking for narcotics (thereby also reducing false positives). Certainly it's a complex issue, and one I'll be interested to watch as it progresses along the often-glacial path to implementation.