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I was recently strongly chastised by a hospital administrator for prescribing a resident of a nursing home, who had been taking large doses of an oral opiate for chronic pain, 4 doses of IM Demerol, 100 mg every 6 hours. I did this to prevent withdrawal while awaiting an appointment with a physician who would manage the chronic pain. I am totally frustrated regarding the liability of prescribing pain medications and am reluctant to prescribe anyone more than a small amount of anything on a one-time basis. I am approaching the point where I believe all opiates should be taken off the market so physicians will no longer be liable for all of the misuse of these substances. I feel like telling patients that they can get heroin without a prescription when they tell me they cannot live without 450 mg of oxycodone daily. There is no such thing as responsible prescribing of opiates. As long as they are available, they will be abused and physicians will be blamed.

By Laurence Schlanger on Aug 07, 2013 at 12:24pm

I would like the NC Med Board to follow the lead of Ohio and REQUIRE prescribers to check the database. 

Ohio requires checking:

(1) If a patient is exhibiting signs of drug abuse or diversion;

(2) When you have a reason to believe the treatment of a patient with controlled substances or tramadol will continue for twelve weeks or more; and

(3) At least once a year thereafter for patients receiving treatment with controlled substances or tramadol for twelve weeks or more.

To me this seems reasonable and prudent.  The goal is to protect the public health and provide effective pain management with opioids to appropriate patients.

By Gary Sims, DO on Aug 08, 2013 at 8:59am

How come no one ever mentions the “P” word when discussing problems with controlled substance prescribing?  After all, drug PROHIBITION is the reason for all these problems (there, I’ve said it…).  Almost 100 years of drug prohibition (and the misinformation that comes from it) have left the US population completely ignorant about psychoactive drugs and at risk from the underground market. And with the lack of legitimate jobs, the diversion of controlled prescriptions provides needed income for many families across the state.  Thus overdoses and deaths occur in NC at an alarming rate.  At least diverted prescription drugs are standardized and quality-controlled.  Still, two 10mg methadone tablets along with some ethanol can be fatal to an opiate-naive person.  I always stress the dangers of a prescription - including diversion - to my patients, especially those with children or teens around. 

P.S.:  The Forum article cites overprescribing of “...Xanex and Vynase…”?  Do you mean Xanax (alprazolam) and Vyvanse (lisdexamfetamine)? - jc,md.

James Stewart Campbell, MD.
MEDesign

By James Stewart Campbell, MD. on Aug 08, 2013 at 11:50am