Let Pharmacists "Prescribe" Painkillers

Doctor, do you resent treating your patients like drug dealers until proven otherwise?

Patient, do you feel like a criminal when you visit your doctor and when you pick up your narcotic prescription from the pharmacy?

We have a mess on our hands with opiate analgesics in this country. Many, if not most, physicians attribute this mess to intrusion from regulators attempting to dictate medical practice starting several years ago when they relabeled pain a "vital sign" and commanded physicians to stop letting their patients suffer and start prescribing more narcotics. Increased prescribing led to more addiction which led to more restriction and regulation which led to higher black market prices which led to reformulation of Oxycontin which led to increasing use of heroin. Introduction of buprenorphine maintenance sparked hope which died as soon as DEA functionaries saw a threat to their livelihood and started systematically harrassing waivered physicians. Meanwhile, over the protests of law enforcement and regulators, and realizing that prohibition of this drug has failed as completely as prohibition of alcohol, a few states have loosened restrictions on marijuana (which deserves its Schedule I status even less than alcohol and tobacco).

Those physicians who still prescribe opiate analgesics regard every patient using the drugs, not as needing help for addiction, but as perpetrating heinous crimes. These physicians might as well wear guns and badges and handcuff patients as soon as they enter the waiting room. They test urine and count pills. In true "gotcha" spirit some wonder whether they can have patients prosecuted for doctor shopping, now a crime in some states. The lure of easy wealth has corrupted others. Government agencies and drug manufacturers have responded with draconian guidelines, rules, and other measures which have wrested control from physician and patient, turning medical practice into a mechanical endeavour.

I propose that physicians abdicate this untenable role. Pharmacists can follow rules and guidelines, are trained to count pills, and by testing their customers' urine can add a new revenue stream for their employers. Let them decide who gets narcotic analgesics and when. Let physicians go back to practicing medicine. Pharmacists should know enough to recommend medication for treatment of pain:

  • Mild pain requires anti-inflammatory drugs, already mostly available over-the-counter.
  • Severe pain requires narcotic analgesics, opiates like oxycodone or buprenorphine.
  • Acute pain requires a small supply.
  • Chronic pain requires a larger supply.
  • How hard is that?

We certainly cannot make these attractive and potentially lethal drugs available over-the-counter like aspirin (at least not now), but regulation on a par with that of alcohol, tobacco, and now marijuana might discourage a black market, reduce access by kids, stop some of the damage, and allow physicians to stop acting like cops with the people they want to help and start practicing medicine again.

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