Tuesday, August 09, 2005

AMA News: Docs urged to detect RX drug abuse

The war on drugs continues.New theaters of operation are always opening up even though the enemy in older venues of combat have not been defeated.Emphasis is currently on the amphetamine issue and more recently CASA ( Center on Addiction and Substance Abuse) targeted prescription drug abuse, said by them to involve 15.1 million Americans in 2003.Since this is an activity that the perpetrators strive to keep secret and admittedly use all manner of lying, cheating and subtifuge to evade detection one cannot help but question the accuracy of this number particularly when done by an agency who has no interest in underestimating the number. This number appears, however, without editorial critique, in the August 8, 2005 issue of AMA News (no link given as this publication is now open to AMA members only). For some reason I cannot hear the term "drug abuse" without thinking of someone hitting a capsule with a hammer or shouting at a pill saying "you dumb SOB, you made me nauseated".I mention this CASA news article only to highlight a recent rant by DB's Medical Rants on the drug war.I agree with his comments completely.
William F. Buckley Jr., of National Review fame,lead a symposium in July 1996 which concluded that the war on drugs had failed. Thomas Szasz in that symposium said that Dr. William Bennett-former drug czar(It was never explained why a government official in the U.S. would be referred to as a czar)-was right when he said that drug use and drug controls were primarily moral issues. Bennett saw self medication as wicked and criminalization of that behavior as virtuous while Szasz saw self medication as a basic right and drug use criminalization as hypocritical and unenforceable.Everyone will not agree with Szasz's libertarian views but Buckley is no libertarian. You do not have to agree with Szasz's views on what he describes as the "myth of mental illness" to appreciate his thoughts on the drug war.
Decades earlier Dr. Milton Friedman said that the deleterious effects of the drug war would be the same or worse that those noted in the Prohibition, which finally got so bad the law was repealed.
The AMA news article was replete with suggestions for doctors to better detect Rx drug abuse such as calling the patient's old doctor, asking the patient if he has a history of drug abuse ( that should work) and medical educators were admonished to do a better job teaching medical students how to detect such behavior.

1 comment:

Dr. Luke Van Tessel said...

I had an outpatient last week with pinpoint pupils--who told me she was taking double the amount of Percocets we had given her--and an attending who refilled her Percocet anyway--even after she said she'd gotten the extras "from a friend." You know why? Because it's easier to refill a prescription than go through all the paperwork of getting a patient out of your practice. And she did have some chronic pain, but some obvious malingered exacerbation of symptoms on physical exam. We'll put her on high-dose duloxetine in addition to the Percs, but I'm not sure she'll take that. The point is that detecting abuse and admonishing patients can take eleven minutes out of a ten-minute visit, to say nothing of ensuring endless CYA paperwork. We are all victims of high-throughput medicine, and while I don't agree with this doctor's decision to retain these patients, I guess I understand.