Breakfast for me usually means coffee, an English muffin, and whatever’s in The New Yorker that draws my attention. Last week, thanks to Rachel Aviv’s thoughtfully written “Prescription for Disaster,” my morning musings have been filled with the troubling problem of “negligent and reckless pain care” when there is “little incentive to do otherwise.”
Aviv’s article is a case study of a well-meaning but overwhelmed doctor in Kansas who prescribed long-term narcotics primarily for low-income people with chronic pain, with sometimes-deadly results. Aviv describes visits and fancy dinners from drug company sales reps, and she talks about the challenges of helping people who have “very tough lives.” The doctor and his nurse/office manager wife are both in prison now. It’s a sad story all around.
The Legislature of CommunicateHealth’s home state of Massachusetts is currently discussing a bill to combat opioid abuse, and we applaud this effort that, among other things, would provide doctors with more training and require pharmacists to dispense safer drugs whenever possible.
But where is health literacy in this discussion? What about patient education in the broader sense, outside of the often-hurried patient-provider conversation? In addition to top-down changes, we also need to educate and support patients from the ground up. This can be done through established health education channels, as well as on the pill bottles themselves.
It’s the doctor’s responsibility to monitor their patients’ use of opioid painkillers, and decide whether patients are using too much — but patients also need to know what they may be getting into when they start taking opioid painkillers. There are probably a lot of people who start out just following their doctor’s orders and end up inadvertently hooked on pain pills. Many factors contribute to this, but patient education must play a role in prevention.
Health educators: If you’re writing a list of questions to ask the doctor about a medication, add a few questions about the risk of addiction. How about:
- Is this drug addictive? If so, how can I take steps to not get addicted to it?
- Is there a less addictive treatment we could try first?
A prescription bottle of hydrocodone-acetaminophen (a.k.a. “Vicodin”) comes covered with warning labels. These labels could be a way to caution patients about limiting their time on the medicine when it’s prescribed for short-term pain relief. In addition to: “Use care using machines,” and “Taking more than recommended may cause breathing problems,” it may help to add a label that says something like: “Taking this drug for longer than 3 months may cause dependence.” (This advice is already listed on MedlinePlus.)
If opioid misuse and abuse is truly a national emergency, it’s time for an approach to prevention that educates not only doctors and pharmacists, but patients as well.