What Should Doctors and Drugmakers Do to Stop Painkiller Addiction?

Q. America is in the grip of a terrible epidemic: addiction to pain-relieving prescription medicines. What responsibility do you think the manufacturers, distributors and prescribers of these drugs have in this crisis?

A. I think they bear plenty of responsibility, which some of them—and their professional associations—have been reluctant to accept.

Ultimately, individuals are responsible for their own health and what they put into their bodies. But when pain is strong and/or chronic, there is a natural tendency for patients to ask for whatever will ease it, and with this comes the risk of addiction to opioids.

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That’s why physicians and dentists need mandatory pain-management training, starting in medical and dental schools and continuing thereafter. They should first prescribe the mildest, nonaddictive, over-the-counter pain remedies. If they step their patients up to more-powerful prescription drugs, they should be required to limit the initial supply, counsel their patients and monitor them carefully for early signs of addiction.

States must maintain well-funded, real-time prescription-drug monitoring programs so that prescribers and pharmacists can spot patients who get prescriptions from multiple physicians, dentists and pharmacies, as well as see patterns of over-prescribing of painkillers by medical professionals—either by negligence or for illegal resale purposes (“pill mills”).

Manufacturers of prescription painkillers have to recognize that some portion of the soaring sales and profits they have enjoyed are coming from both overuse by legitimate patients and illegal black markets. Some manufacturers are belatedly endorsing mandatory physician training in pain management and even physician licensing by the federal Drug Enforcement Administration for prescribing opioids.

Sadly, tougher training and prescribing standards for American health care professionals are not enough. The addiction epidemic is now being fed by supply chains that go far beyond U.S. drugmakers and medical professionals. An internet mail-order market is flourishing, and foreign supplies of generic opioids are flooding into our country. China has agreed to ban the export of more than 100 drugs, but new sources are constantly arising. This epidemic must be fought on many fronts.