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With no way to track users, Missouri medical associations try to cut back on narcotics prescriptions

Pills prescription drugs pharmaceuticals
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A patient comes into an emergency room, clearly in pain and begging for medication. Is she physically ill or addicted to narcotics? It’s almost impossible to tell. But a new set of guidelines for emergency physicians, primary care providers and dentists may help doctors sort through those questions.

“Every day in the emergency department, I see patients who currently have or have had issues with narcotic medications,” said Dr. Matthew Treaster, an emergency physician for SSM Health.

Codeine, OxyCotin and other opioid-based pain medications are frequently cited as a precursor to their cheaper, harsher cousin: heroin (some doctors, however, dispute this generalization). An October study showed that opioid drug overdoses in Missouri accounted for 25,711 hospitalizations in 2014, a rate more than twice as high as it was ten years ago. Hospitals in the St. Louis region treat nearly half of those overdoses.

“They’re prescribed pain medications for real pain, and they do need these medicines. But unfortunately these medicines are very potent and are quite addictive,” Treaster said.  

For Missouri doctors the decision to write a prescription is even more difficult because Missouri remains the only state in the country that has not established a system to alert pharmacists when a patient may be “doctor shopping” for extra prescriptions for narcotics.

“I have to rely on the patient’s honesty or memory,” Treaster said.

To prescribe or not to prescribe? Missouri’s doctors have decided to answer that question for themselves. On Tuesday, six of the state’s professional associations for medical providers released a set of ten guidelines to help doctors reduce the number of pain pills they prescribe, including:

  • Doctors should attempt to contact a patient’s primary care provider before writing a prescription for chronic pain.
  • For short term, or acute pain, doctors should limit prescriptions for opioids to a 72-hour supply.  
  • For new diagnoses, doctors should limit a prescription to the shortest duration possible, while still effectively controling a patient’s pain.
  • Emergency physicians should not provide prescriptions for narcotics if a patient claims they are lost or destroyed.
  • Dentists should avoid prescribing narcotics for moderate tooth pain.
  • Encourage policies to allow the prescription and distribution of naloxone as an antidote for opioid overdoses.

Dr. Evan Schwarz, a physician with Barnes-Jewish Hospital, said the rules won’t fix the issue, but it’s a start. He also said that the rules should help alleviate the pressure doctors have to make sure patients are happy with the service they receive. Patient satisfaction can affect a hospital’s funding and doctors sometimes feel pressured to prescribe pain medication despite misgivings. That situation can be mediated by the guidelines, Schwarz said.
“It’ll help some physicians, hopefully, to feel empowered that if they don’t feel it’s proper to prescribe someone narcotics, they feel they have the support that they can explain why,” Schwarz said.          

Follow Durrie on Twitter: @durrieB