Given the current opioid crisis, I have been wondering about how the situation got where it is today. As someone who lives with chronic pain due to a neuropathy resulting from abdominal surgery, I can relate to the anxiety and fear associated with knowing you will be in pain and that you need medicine to control it. I was initially given opioids to manage the post-operative pain and I wound up getting several subsequent prescriptions to manage the ongoing pain. However, I no longer need or take opioids, despite having used them for 2 years before finding non-opioid medications to manage the neuropathy. I never became addicted, but as a scientist with a PhD in pharmacology, I may be atypical. Nevertheless, addiction is not a guaranteed consequence of being prescribed opioids.
I think several factors converged to lead to the current situation. The worst is the overzealous, unethical, and criminal marketing of drugs like Oxycontin as nonaddictive, safe solutions for pain management. Another is the inappropriate dispensing of opioid prescriptions without providing adequate counseling about addictive potential or considering the risks of addiction in specific patients. Another contributor is how addiction is managed. Once a person has become addicted to opioids, it is unreasonable to think that he or she will be able to stop just because the doctor won’t provide another prescription. Simply cutting the patient off will either lead the patient to “shop” for a doctor to write a prescription or the patient seeking illegally acquired drugs to manage the addiction.
I have another idea. Can the availability of over-the-counter (OTC) pain medication have contributed? Has the perception that the only reason to visit a doctor is to get a referral or a prescription resulted in more people getting access to opioids than would have before there were the OTC pain relievers available today?
People have ready access to many different brand-name and generic drugs containing the nonsteroidal antiinflammatory drugs aspirin, ibuprofen, or naproxen. Some people would rather self-medicate with an OTC pain reliever than see a doctor. Without guidance from a doctor, this may result in less effective resolution of the source of the pain through suboptimal dosing of the OTC pain reliever, lack of any behavioral changes that could reduce the pain or prevent the pain from recurring, or lack of alternative strategies to treat the source of the pain or manage the associated anxiety.
Once a person decides to see the doctor, the doctor may not recommend an OTC pain reliever, because the patient may have claimed to already have tried them without success. Can the doctor be sure that the patient took the right dose on the right schedule along with other non-medicine–based strategies to reduce or manage the pain or resolve the underlying cause of the pain? Alternatively, a doctor may recommend taking OTC pain relievers without providing clear instructions for how much, how frequently, and for how long. The doctor may not write out the exact treatment strategy for the patient to follow. There is no prescription for the pharmacist to make into a label for the patient for the OTC medication. Consequently, the patient may not get effective pain relief from the recommended OTC pain reliever and return to the doctor requesting something stronger. In the end, a person, who may not even have needed an opioid, may wind up with a prescription for them.
Patients need to change the mindset that a doctor visit has to result in a prescription, and doctors need to provide clear written instructions for the effective use of OTC pain relievers just as if those were being obtained through a prescription.
Opioid Crisis, National Institute on Drug Abuse. Updated June 2017. (Accessed 6 October 2017)
Armstrong, D., Secret Trove Reveals Bold ‘Crusade’ to Make OxyContin a Blockbuster. STAT (22 September 2016) https://www.statnews.com/2016/09/22/abbott-oxycontin-crusade/
Cite as: N. R. Gough, No Prescription Required but Maybe Needed? BioSerendipity (6 October 2017) https://www.bioserendipity.com/no-prescription-required-but-maybe-needed/.