Your primary care doctor may know best about what ails you, but it seems that plenty of them are somewhat in the dark about the risks surrounding prescription painkillers, according to a recent study published in the Clinical Journal of Pain.
The authors conducted a survey of 1,000 internists, family physicians, and general practitioners last year through the mail, with about 58 percent of them replying back. While all the doctors were quick to acknowledge that the abuse of prescription drugs was a real problem within their communities, there was numerous misconceptions they held about it.
For one, only 66 percent knew that the most common method of prescription drug abuse was simply through pill-swallowing. Though these addictive painkillers are often extravagantly portrayed as being crushed and snorted or injected by its illicit users, in reality, that rarely happens.
Related to that erroneous belief is the idea that drugs which are specifically made to be uncrushable are somehow less addictive than their standard version. Logically speaking, that’s the equivalent of believing that a child-proof bottle of bug spray would be any less hazardous for someone to accidentally ingest, and yet nearly half of the doctors endorsed it.
Similarly foolhardy was the perception that opioids entering the black market through legitimate providers wasn’t a major concern, held by 25 percent of physicians. However, the authors note that "this practice is in fact common at all levels of the pharmaceutical supply chain."
These mistaken ideas may come with some very serious consequences, according to the authors. "Physicians and patients may mistakenly view these medicines as safe in one form and dangerous in another, but these products are addictive no matter how you take them," said lead author Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health, in a press statement. "If doctors and patients fail to understand this, they may believe opioids are safer than is actually the case and prescribe them more readily than they should."
And while certainly not the only force behind the exploding rates of prescription drug abuse seen over the past decade, Alexander believes that these gaps in knowledge have contributed to it. "Doctors continue to overestimate the effectiveness of prescription pain medications and underestimate their risks, and that’s why we are facing such a public health crisis,” Alexander said.
On the positive side of things, the authors did find that primary care doctors are overwhelmingly in support of policies that may combat abuse, such as requiring patients to sign contracts swearing that they will not engage in abuse (98 percent), urine testing (90 percent), and creating a centralized database that doctors can look at before they prescribe further drugs (80 percent), among other interventions.
Though Alexander is encouraged by these latter findings, he notes it will be an uphill battle for doctors to find the time and resources to carry out many of these proposed ideas. "Despite the high levels of support, there are many barriers to implementation and there may be reluctance to translate these changes into real-world practice," he said. "But for the sake of making a dent in an epidemic of injuries and deaths, we have to find ways to make changes. Too many lives are at stake to stick with the status quo."
According to the Centers for Disease Control, in 2013, there were over 16,000 deaths in the United States as a result of prescription painkillers, and nearly two million people who were addicted to or abused these drugs.
Perhaps by better educating those responsible for prescribing these admittedly lifesaving medications, those numbers can begin to climb down.
Source: Hwang C, Turner L, Kruszewski S, et al. Primary Care Physicians' Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion. Clinical Journal of Pain. 2015.