IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OPIOIDS?

Is the Emergency Department Responsible for Overprescribing Opioids?

Courtney Carnahan
Salt Lake Community College

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

INTRODUCTION
In this case we will learn about Dr. Jones, who is an emergency room physician in
Baltimore. He meets with Marie, who is 25 years old, and is complaining of extreme abdominal
and knee pain over the past twelve hours. She explains to Dr. Jones that she is in great distress
and rates her pain at a ten. When Dr. Jones tries to assess the situation by palpating her abdomen
and knees she refuses to let him. He sees no sign of excessive swelling or redness as he examines
her.
After assessing her he reviews her chart to find a long list of emergency room visits
within the past two years. In her charts it shows that she has a previous diagnosis of sickle cell
disease. She explains that the pain she is experiencing is similar to the pain she felt with her
sickle cell, and that Dilaudid (a strong opioid drug also known as hydromorphone) helped. On
most of her ER visits her peripheral blood smear reports were inconclusive for any vasoocclusive crisis. Her hematologist also notes that she is habitually noncompliant, and that they
have considered consulting psychiatry to help address her persistent chronic pain. A colleague of
Dr. Jones notices that he was going through Maries file and says Good luck with her, shes pro
at getting drugs. As Doctor Jones reenters her room she is asking him for something to relieve
her pain.
THESIS
Should Dr. Jones give her the pain relief medication knowing the history of her excessive
ER visits? Studies show that between 1999 to present that there has been a 300 percent increase
of opiate prescription in the U.S. What does this say about doctors and how freely they are
distributing opiates to patients? A shocking amount of 500,000 emergency department visits

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

happen annually from misuse and drug abuse of prescription painkillers. As well as 36,000
Americans dying from drug overdoses in 2008, and over 12 million Americans admitting to
using prescription drugs recreationally in 2010. If Dr. Jones prescribes Marie an opiate to relieve
her pain is he going to be adding to the statistics, or helping Marie manage her pain?
BODY

Medical Indications
Marie enters the doctors office and is complaining of pain in her abdomen and knees. As
Dr.Jones reviews her chart he notices that Marie has had various ER visits in the last two years.
In Maries case her illness doesnt seem to be chronic, acute, critical, etc. Dr. Kapoor one of Dr.
Jones colleagues mentions that Marie is pro at getting drugs. As said earlier when he returns to
meet with her she is asking for anything to relieve the pain. Does Marie really have any pain or is
she in there trying to obtain prescription opiates? In Maries case as well as other cases that are
similar, the goal of Dr. Jones is to relieve Maries pain without feeding her need for pain
management. In trying to assess Maries case without assuming the worst, giving her various
treatment options could either benefit her, or in worst case make her issue worse. If Dr. Jones
prescribes the prescription opiates is she going to come back with a new case when she runs out
of them?

Patient Preferences
In Maries case she is mentally capable and prefers prescription drugs to help to manage
her pain. When doctors review her charts and see her frequent ER visits in a span of two years it
could make any physician suspicious. Is anyone that is seeking prescription opiates really aware

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

of the benefits and risks? In 2003 the FDA cited the manufacturer of OxyContin twice for their
use of advertisements to promote their products to physicians, and how they down played the
addictive risks of the drug. Are patients and doctors being misled in the use of opiate drugs, and
how they are being prescribed? In Maries case although her preference for her pain management
is the use of prescription drugs, she may not know all the risks that come from using them such
as being addicted to them.

Quality of Life

If Marie goes on without treatment from Dr.Jones she may go searching for other doctors and
find new illnesses to get the prescription drugs that she needs to fulfill her want for them. In
Maries case, judgement could be made that she is not getting the healthcare for a possible
mental illness she may be suffering from. This quality of life for Marie may be exactly what she
desires, and some may look down on that. If its what Marie wants than who are we to judge?
Biases that could influence Doctor Jones opinion could be the experiences he has had with
former patients with a case that is similar to Maries. The ethical issues that arise in this case on
whether or not Maries quality of life is enhancing could be that she may seek medical care for
issues that arent occurring. An article from NCBI states that the quality of life among active
substance abusers and treatment seekers is poorer than those among cohorts without substance
abuse.

Contextual Features
Several factors can vary in the context of Maries case as well as other cases that are
similar to hers. Finding a balance between patients who are legitimately suffering from pain and

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

those who are finding an issue to fulfill their want for their opiate addictions can be difficult.
They have made web-based prescription monitoring programs (PMPs) that are allowing
physicians to assess who else is prescribing scheduled drugs to the patients that other physicians
other than themselves are seeing. This allows doctors and other practitioners to share information
about patients they believe are at risk including Marie in this instance. Legal issues that could
arise in Maries case could be the doctor prescribing a drug that could potentially harm her in the
long run, and get her even more addicted than she is to prescription drugs.

Alternative Option
Some individuals may believe that prescription drugs should be advertised directly to
customers. The only two countries that it is illegal for direct-to-consumer advertisement of
prescription drugs is the United States and New Zealand. Those who support direct-to-consumer
ads believe that the ads inform patients about diseases and possible treatments, allow people to
seek medical advice as well as encourage it, helps remove the stigma that is associated with
medical conditions, and lastly it provides the needed sales revenue to fund costly research
development of new drugs.
Conclusion
Patients who are seeking for prescription drugs will become experts in getting what they
are intending to get. With the issues that arise in patients who doctor shop for prescription
drugs has caused a conflict of interest within doctors and business who are selling prescription
drugs. For some doctors it may be the easy way to get a patient out of their office. It may be
easier to write them a prescription for a drug, instead of taking the time to figure out the real
problem. As a medical community they have created patients like Marie. With the lack of

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

knowledge to better take care of pain management patients, it has prompted more physicians to
prescribe more and more opiates, which in turn had Marie and other patients coming back for
more. As said by Pamela L. Pentin, JD, MD It is time to take back the management of pain with
opiates from JCAHO, from administrators, and from the pharmaceutical industry and place it
where it belongsin the hands of cautious and well-informed practitioners. And sometimes the
right thing to do to is just to say no.

IS THE EMERGENCY DEPARTMENT RESPONSIBLE FOR OVERPRESCRIBING OF DRUGS?

Bibliography
Laudet, A. B. (2011). The Case for Considering Quality of Life in Addiction Research and
Clinical Practice. Retrieved December 12, 2016, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188817/

Pentin, P. L., JD, MD. (2013, May). AMA Journal of Ethics. Retrieved December 1, 2016,
from http://journalofethics.ama-assn.org/2013/05/ecas2-1305.html

Prescription Drug Ads ProCon.org. (2016, September 7). Retrieved December 12, 2016, from
http://prescriptiondrugs.procon.org/