Letter to the Editor
Thomas Cook, MD, stated that we should look “in a mirror” for answers to the opioid storm. (“The Perfect Opioid Storm: How We Got Here,” EMN 2018;40:22; http://bit.ly/2NickJW.) Which mirror? The side-view mirror we check to see if an administrator is looking over our shoulder? Or the rear-view mirror that looks back on patient satisfaction?
To suggest that EPs should examine (and ascribe blame to) themselves for the cause of the opioid epidemic feels a bit off, not because self-examination is bad or EPs have never prescribed opiates, but because EPs were against the pain-as-the-fifth-vital-sign mandate from the beginning. That mandate had almost the same weight as EMTALA. We were penalized for not addressing pain, and were forced to practice medicine according to patient satisfaction scores and ledgers.
All my colleagues are reluctant to prescribe narcotics. There is a collective groan when a patient says his ankle pain is 9/10 and he wants something stronger than ibuprofen. EPs invented the drug-seeker log and have used it as a prevention tool.
My ED group lobbied for hospital policy changes stating that we do not refill narcotic prescriptions and we do not give IV or IM narcotics for chronic pain exacerbations. These policies have resulted in measurable decreases in ED visits for chronic pain and drug-seeking. When a physician can confidently say hospital policy prevents him from refilling a prescription, the drug-seeker has nowhere else to go but another hospital.
I think we can look in the mirror and feel pretty good that we have done what we can to prevent the abuse of narcotics and medications despite the “good intentions” of our handlers.
Claus Hecht, MD