Relieving Pain
Here is Mark Kleiman via Matt Yglesias:
Physicians …have tended to be sparing in their use of opiate and opioid pain relievers, even when the pain involved is extreme and the patient’s short life expectancy, as in the case of terminal cancer patients, makes addiction a largely notional problem….
Current policies are scaring physicians away from treating pain aggressively. Many doctors and medical groups now simply refuse to write prescriptions for any substance in Schedule II, the most tightly regulated group of prescription drugs, including the most potent opiate and opioid pain-relievers and the potent amphetamine stimulants. The opiate-and-stimulant combination the textbooks recommend for treating chronic pain is almost never given in practice for fear (a fear well in excess of the actual risk) of disciplinary action and criminal investigation for a physician prescribing “uppers and downers” together.
Here is Yglesias’comment:
One of the most interesting findings from the happiness research literature is that human beings are remarkably good at adapting to all kinds of misfortunes. Chronic pain, however, is an exception. People either get effective treatment for their pain, or else they’re miserable. Adaptation is fairly minimum. The upshot is that from a real human welfare perspective, we ought to put a lot of weight on making sure that people with chronic pain get the best treatment possible. Minimizing addiction is a fine public policy goal, but the priority should be on making sure that people with legitimate needs can get medicine.
Physicians’ fear of going to jail if government says that they are over prescribing pain meds is characterized as “A fear well in excess of the actual risk.”
It would be nice to see some analysis of “the actual risk” and why the fear is excessive.
The article assumes that physicians are irrational. It says that the (supposed) low risk generates so much fear that “[m]any doctors and medical groups now simply refuse to write prescriptions for any substance in Schedule II.”
As an economist, I assume that people are innocent of irrationality until they are proven irrational. In this case, maybe the analyst should investigate what it is that the government has done that has made an activity so risky that an entire group of people refuses to participate in it.
I agree with Linda. Bad government policy is the cause of this problem.
My neighbor has built a nice legal career defending doctors against DEA attempts to limit the amount of pain medication they are allowed to prescribe.
My brother-in-law works in a community health center. He announces to all of his patients that he does not prescribe schedule II pain relievers. His fear is mainly the doctor shopping by drug addicts and people reselling the drugs.
Devon, does your brother-in-law fear that the drug addicts and resellers will harm him or that the government will harm him simply because he was duped?
Linda, I believe it has more to do with the fact that he has a full caseload of patients who really need his help. He doesn’t want to fill up his days dealing with people who lie about chronic pain to get hydrocodone. He just refers them to the pain specialist.
Brilliant post, but Pain Relief Osteoarthritis is something that is badly needed, especially for older people. Schadenfreude may not be applicable here!