The Wall Street Journal ran an article on October 6 called "Prescription for Addiction" talking about the national epidemic of prescription pain killer addiction. The article detailed the tragic story of Jaclyn Kinkade and her struggles with addiction. As with many tragedies (such as the current issue debating the proper regulation of compounding pharmacies), the first reaction by many is to call for greater government regulation. After the article was published, a number of very profound letters were submitted to the editor and many of them focused on the government response. I wanted to share two of these.
"Rampant narcotic overusage, as profiled in your article, is undeniable, but it is worth looking beyond the local practitioner and drug companies. The parallels between this awful mess and the mortgage meltdown are instructive. In both cases, top-down planning from government agencies and quasi-government agencies forced the promiscuous use of products. The late 1990s saw "pain control" become a mandate, with top-down involvement from such agencies as the Joint Commission, the Department of Veterans Affairs and the American Medical Association. California passed a bill mandating "appropriate" pain management. Pain control became a right.
Like mortgage brokers, health-care practitioners became the intermediaries of this mandate; some sleazy ones succumbed to the easy financial incentives. However, there have been many conscientious physicians who increased prescribing narcotic pain medications to comply with their perception of the government and accreditation requirements.
Much like mortgages, a top-down overreaction is now evolving. Just as it is difficult for qualified buyers to obtain a mortgage for a reasonably valued home, the patient who truly needs pain medication is having increasing difficulties ("Making the 'Pharmacy Crawl,'" U.S. News, Sept. 27). More regulations are unlikely to help anyone." — Richard Zoraster, MD, Whittier, CA
"The story of Jaclyn Kinkade is a tragic one, but why name every manufacturer of a legitimate pain medication? These drugs, properly used, are life-changers for many people. If there's a villain here, it's the rare doctor who writes excessive prescriptions or doesn't educate his patients.
The patient, of course, bears a reasonability to understand what he's doing to himself.
Like alcoholism, one makes a conscious decision to give oneself this "disease" and to remain sick"
— Mark Stamm, Potomac, MD
These issues are significant for physicians dispensing medications from their clinics as well as pharmacies and pharmaceutical wholesalers. Patients increasingly practitioners to fix everything so we can experience happy, pain-free lives. There seems to be a pill for every ailment. In an effort to protect the public, the regulators seek to put tighter controls on all those things that are bad for us. Regulations morph from a collection of laws protecting our rights from encroachment by others to trying to protect us from ourselves.
This article and the responding letters are the kernel of a important debate on a very challenging issue. Trending in this arena could pose a danger to medication dispensing as well as other aspects of the clinician's practice. In light of current trends in healthcare oversight and regulation, I hope we continue to see healthy discussion before conclusions are drawn and a host of new regulations are thrust upon all of us working hard to manage the legal and ethical aspects of this national challenge.
