Prescription Drug Abuse: Blame Doctors

The medical establishment is at fault for needless deaths because it prescribes too many drugs and fails to monitor patients’ use of them. Pro or con?

Pro: Loose Cannons in Tablet Form

The highly anticipated Batman film will premiere later this month, but unfortunately the Joker will be missing from the red carpet. It’s been almost six months since toxicology reports revealed that the death of actor Heath Ledger resulted from an accidental overdose—a fatal interaction of prescription drugs including pain, sleeping, and anti-anxiety medications. The Oscar nominee was taking six different legitimately prescribed drugs including Xanax, Valium, and Restoril—all considered, for the most part, to be safe. However, the medical community has done little to address this problem, and it’s certainly nothing to joke about.

The Centers for Disease Control & Prevention reported in 2004 that 14 million patients misuse their medications and more than 20,000 cases a year result in an unintentional death. In the U.S., painkillers such as OxyContin and Vicodin, the ones prescribed to Ledger, are more likely to cause a fatal overdose than heroin or cocaine. These accidents can be prevented, and the burden should fall on the medical community. Taking care of patients does not mean prescribing a quick, easy refill.

And refilling they are. In 2005, Medicaid spent $5.4 billion on antipsychotic drugs including Seroquel because of its prevalent misuse to treat Alzheimer’s. The Centers for Medicare & Medicaid Services reported that 30% of the nursing home population is receiving an antipsychotic, yet 21% of those cases do not suffer from psychosis. And the trend extends to all age groups, not just the elderly. In 2007 doctors filled more than 45 million prescriptions for an antipsychotic, according to IMS Health. Yet there are only 2.4 million schizophrenic patients (for whom the drugs were originally intended), according to the National Institute of Mental Health.

That’s just the overprescription of one pill. The heightened risk of patients’ mixing medication is also carelessly assessed by the medical establishment. Doctors and pharmacists don’t share medical records, and they assume patients are drug-free when they step into the office, meaning they can prescribe a drug that proves deadly when combined with a previous Rx from another doctor.

Furthermore, the 2008 shooting at Northern Illinois University that claimed the lives of six students has been linked to the gunman’s abrupt discontinuation of prescription pills Ambien, Prozac, and Xanax. This tragedy should remind doctors of the need to monitor their patients closely, not only when they start their prescriptions but also right after they stop.

Con: Patients Should Be Accountable

New prescription drugs are allowing people to live longer and healthier lives than ever before. These pharmaceuticals help patients with conditions from depression and anxiety to high blood pressure and cholesterol, problems that were often inadequately treated.

For example, cholesterol-lowering Lipitor, introduced in 1997, quickly became the best-selling drug in pharmaceutical history, helping 26 million Americans contend with heart disease, the top health problem in the U.S.

Indeed, the use of newer drugs ranks as the most important contributor to increases in U.S. longevity, according to a 2007 study by the Manhattan Institute, a conservative think tank.

There’s no question that prescriptions are being written at a record rate. Prescription purchases increased 71%, to 3.6 billion, from 1994 to 2005, while the U.S. population grew just 9%, according to the Henry J. Kaiser Family Foundation.

In addition to new drugs driving demand, the nation’s swelling senior and overweight populations are among several factors contributing to the sharp rise.

As more medicines become available, more are also abused or used incorrectly. As the deaths of Heath Ledger and Anna Nicole Smith tragically illustrated, misuse can turn deadly.

Yes, drugmakers woo doctors to prescribe more of their products, but the percentage of medical professionals who recklessly sign Rx forms is tiny. The vast majority do what they think is best for the patient, and carefully track use.

More scrutiny is needed to ensure proper prescription and use of medications, but doctors alone cannot be blamed for incorrect usage. Instead, the medical establishment, the government, and patients themselves must share the responsibility.

Today, doctors have less time with each patient, and patients frequently switch health-care providers. It means that doctors aren’t able to track patients as they once could.

Ideally, doctors would know exactly what a patient is taking. But without shared records, health-care providers often have incomplete information. This allows the unwitting use of dangerous drug combinations, or "doctor shopping," when patients get more drugs than needed from various sources by lying about what they are already taking.

One response: government-run, Internet-based, drug-tracking systems that keep tabs on who is getting what. Twenty-six states had prescription monitoring programs as of December 2007; nine more are planned, according to the Drug Enforcement Administration. These programs are imperfect—they only track prescriptions statewide, for example—but they help. Patients must also do their part by taking responsibility for their own drug use.

Opinions and conclusions expressed in the BusinessWeek Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

maur911

It is obvious prescription drugs are out of control. High profits are the reason for mandatory vaccinations. Autism is at a rate of 1 in 152 children in the USA due to mercury in these injections. What makes it worse is that 90% of drugs on the market have not been properly tested. Let your immune system keep you healthy by staying off sugar, etc.

tony lobo

Everyone wants a quick fix, nobody wants to change, and everyone out there still believes there is a drug to treat whatever they need to be treated for. The patient must take time to find out more about the illness and its limitations. Information is available today--search.

sue

Pharmacies already have a pretty good system to check customers' existing prescriptions, but only with that pharmacy. It would be helpful if pharmacies could tap into a universal, secure information base, available only to pharmacies, to check on what drugs their customers are already taking.

Abbie Kendall

Assuming a patient is of sound mind, then any drug "abuse" is the fault of the patient. Prescription drugs are no more out of control than is the eating of carrots.

There are many chronic, painful, and debilitating conditions that can now be treated thanks to the researchers, scientists, pharmaceutical companies, and physicians who participate in drug development and distribution.

As for Mr. Ledger, he did kill himself, either accidentally because he did not read and follow dosing directions or did not share with all of his physicians the list of medications he was taking. Or, he died purposely because he used several physician to gain subscriptions to medications that could prove deadly when mixed. Either way, quite a sad result.

As for some of the comments by others: The last entity that should be tracking individuals' use of medicine is the government. My pharmacy tracks the medicines I am prescribed. And, if I move or switch pharmacies, it is my responsibility to inform the new pharmacy of the medications I take regularly.

Re vaccinations and autism, there is no scientific proof showing any correlation. None whatsoever.

And the claim that 90% of the drugs on the market have not been thoroughly tested? Rubbish. By the way, sugar intake has no relation to one's immune system. My goodness, ignorance abounds.

mike

What they need to do is legalize marijuana for medical use so they will not have to deal with deaths from somebody abusing their prescriptions.

Phoenix

Both are at fault. Doctors should educate their patients to check on the compatibility of their drugs, and patients should ascertain that they are not taking a fatal cocktail.

Tracy

What ever happened to taking responsibility for yourself? Now you are blaming doctors and want the gubmint to track you?

This all reminds me of the Carter years when he was blaming citizens for increasing their spending as he devalued the dollar like there was no tomorrow.

Angela

It is the patient's duty to safe-guard their own life. As another commenter said, the controlling of what pills go into your mouth is (usually) on the same course as what food goes in. Even addicts know that they are taking chances--it is people who have built up tolerance and think that one or two more will finally help them, those are the ones, like desperate Heath Ledger, for pain relief and sleep (desperate) who end up accidentally killing themselves. You cannot blame your doctor. I was recently offered OxyContin by my doctor and decided to stick to the "weaker" pain killer I take for a broken neck. Too dangerous for my tastes. You can say no to Rx and if you say yes, it's up to you to be responsible about taking it. Also: You can kill yourself with tons of other OTC items, so certainly doctors cannot be blamed for all mishaps that occur. Just my two pills--er, cents.

Anne V.

Preventing prescription drug abuse is the responsibility of the doctor writing the prescription. The medical community has yet to deal with the shameful stain on such an admirable profession. Prescription drug abuse is damaging the credibility of physicians and physicians must regain control of that.

To be part of the solution, not the problem, doctors must report other doctors who are engaged in prescribing violations. One bad doctor can prescribe a million pills a year or more, and this does not go unnoticed by their peers. Step up to the plate, let go of the culture of silence and start being good citizen again! Doctors are responsible for patient safety, all patient safety.

Community pharmacists are struggling for professional identity and for good reason. They are medical professionals functioning in a corporate culture, perhaps more then any of health care providers. However, they are licensed and they should reflect the professional responsibility of a licensed medical professional. Honest pharmacists admit they frequently dispense medication to patients abusing prescription drugs and are dismissed by uncooperative doctors prescribing the drugs to abuse.

Pharmacists have lost professionalism to misguided corporate priorities. Profits and patient safety is a conflict of interest with deadly consequences. Corporations are in control of professional ethics. Government must clarify the ethical rules of the road.

The medical profession must remove the business model and replace it with a strict standard of care focused on appropriate prescribing and dispensing medication. Pharmacists generally do not report doctors who are prescribing narcotic for no legitimate medical purpose, because profits are the priority; safety of citizens is not. The solution will require pharmacists to report physicians engaged in care that risks the health, safety, and welfare of the patient. If you suspect a doctor is practicing medicine in a manner that risks the patient, pick up the phone and make a call.

Physicians and pharmacist must ensure patient safety above profits. When they can’t, regulatory oversight must bring clarity to the blurry line of patient care and business venture.

Kiki

I agree that patients have their share of responsibility when it comes to the use of drugs.

However, when patients are being educated to "put their lives in the doctor's hands because they know what is best" and trust those doctors, we have a big problem.

What I have seen time and again is that since I've finally decided to take control of my own health care, my doctor began saying that I was uncooperative. I'm being told by my insurance company that "I should be cooperating with this doctor" or they'll cut off my policy.

At the same time, the doctor doesn't do anything for me except offer drugs. And I've changed doctors but I get the same type of response.

And let us not forget all the rude, inappropriate comments doctors make. I, for one, am tired of doctors who have gotten no more than a slap on the wrist for sexually assaulting patients.

I am also tired of hearing about doctors who drug their patients but yet get no more than a slap on the wrist for it, if that? It is the doctor's responsibility to not write out too many prescriptions for these drugs.

It is the patient's responsibility to tell these quacks where they can shove those prescriptions when they are over-prescribed.

As a patient, I'm sick and tired of being told that "I must take this drug or that drug" both by my doctor and by my insurance company.

I should have the right to choose whether I want to take a drug or not without having to concern myself with "insurance company" policy. I also should have the right to see the type of doctor I want to see--as after years of drugs and more drugs and still more drugs, I now am a firm believer in alternative medicine.

Yet, I don't have the right to see an alternative practitioner.

As for the health care I'm getting now, it is a joke.

my2cents

The bad part about about this all: There are a lot of people that search for drugs through doctors with intent to abuse them. Then there are people that need the meds for bad pain that is causing them to suffer. Problem is how the doctor determines if the person is out for drugs or just help with pain control. I was in a car accident--hurt bad and can't get help because the doctor puts me in a catagory with those that abuse. I haven't been to a doctor in over 5 years. If I was seeking drugs I would have been going to a lot of doctors trying. The doctors need the ability to determine who is in need and who is just looking for drugs. They give them to people that want to abuse or sell them to profit off of taxpayers' money but they don't want to give them to people in need because of an injury. I have been going through chiropractic care trying to get some relief. I am in so much pain that I can barly tolerate treatment. It has helped to relieve some of the smaller symptoms that are agravating the more serious problems. But I need pain control till I can handle natural treatment. I don't like to take meds much. These doctors give you a few pain pills, enough to let you know they help. Then when you ask for more because they are gone, they act like you're abusing them. That would be understandable if it were before the recomended dose was up. I think that the doctors should have to be trained to better determine who is looking for drugs and who is in need. But that is just my 2 cents.

Eileen

I agree that doctors give out medication far too easily and without the proper education to patients. I worked as a nurse in a cancer clinic and saw so much inappropriate gving of medication. Pills, pills, pills. Pain meds are addicting. I got addicted after back surgery. My doctor knew I had had problems with my meds but kept on prescribing them. Although I had pain, it was never suggested that we should see how things went on a lower dose or try alternative treatment. Staying on the meds changes you and your thought processes. I started a med that stops the craving and learned that I was really an addict. I did not believe it, but it is true. Why aren't they telling the whole story of the meds? I do not believe that telling me it was okay to take without a thorough examination. Anyone on ongoing meds should be thoroughly examined for addiction. I had convinced myself my pain should be treated. I could not see another way. I say that the meds were given so easily in the clinic that they must be fine, but they are not really safe. Doctors need to take more responsibility for what they do

crissy

Doctors do overmedicate their patients. I have diabetes and every time I enter the doctor's office with any type of pain, I'm given a prescription without even testing for the cause. I one day asked the doctor if she thinks all diabetics will encounter the same fate. The reason for that question seems that all I ever hear is diabetics have this and is known to eventually get that. I felt that in honest respect of the patient that's being treated, they should only receive treatment for the present disease and not something other than. Taking these preventative measures of distrubuting these medications when patient really don't need them will only keep them testing forever more. Each medication must be carefully monitored for side effects and causes of another or potentially deadly illness. This can be very costly as well and very bad for the patient overall health. As for the malpractice, doctors they should test their patient and not just treat them with prescriptions which could also be deadly or cause a serious injury. Let's think about this, how can a doctor treat a illness if he has no diagnosis of what he's treating? No testing means "It might be this or it can be that." That is a receipe for what is known to be medical malpractice for sure. If we were to remove or change the malpractice cap then our country would be looking at death and injury at an alarming rate. Malpractice helps to keep the prospect of saving lives, not taking them. A good doctor who does what is in the best interest of his patient will not have to worry about a law suit because his work and conduct will speak for itself. It is those doctors who cause harm whether it's emotional or physical; that is the problem. The ones who says that some of the law suits are friolous are talking about the emotional cases within the law. Sometime the emotional state is something more disturbing then the marks seen with the naked eye. We must all address the health care issues as people of concern and pointing fingers will not help to make the necessary changes needed to fix it. Just as Wall Street went down in a crash, so will our health care. Money is the root of all evil and we must come to terms with making sure we alleviate this high end business and look through the glass and see what's really going on. We must also see who is benefiting by what's occurring or it will become another bubble waiting to explode, like the housing market did and Wall Street as well. Also I would like to say that it is not the malpractice that becomes the issue; it is also the cover-up and lies that becomes the issue. Doctors can say I mess up and I apologize but yet instead they cover it up. Doctor's are human as everyone else and mistakes do occur, but when they go and try to hide their mistakes is also when a lawsuit will most definitely occur. I recently had a bad experience and almost lost my life, but I had a doctor explain the mistake and I didn't sue the doctor because of it. It is unfair for anyone to call it frivilous because they are not the one being injured. Emotionally or physically either way it is unjust. Doctors know what they are facing when entering into this field of work and also know that there will be a cause and effect when things are not done properly. If they are overworked or underpaid it is best then to just walk away than to seriously harm more then help your patients. I also work and love my job. I take pride and what I do for my clients as though they was one of my own. If doctors begin to view patients as a loved one, perhaps better health care would be given and fewer malpractice cases would evolve. This is just another one of my opinions.

Bonita

I have watched my beautiful strong athletic daughter turn into a sometime zombie-like sickly person who can't even walk straight because of being overmedicated for some affliction that I don't really feel she has. Her husband is just trying to work and take care of their 7 year old son and doesn't know really what to do. I love my daughter so much, and wish I could find out what we can do. One night she left her bag of medications here so I had my son write them all down. I showed my husband's nurse's aid and she just shook her head at all the medications. I believe that doctors and pharmacies should be monitored closer.

Jennes

Taking these preventative measures of distrubuting these medications when patients really don't need them will only keep them testing forever more. Each medication must be carefully monitored for side effects and causes of another or potentially deadly illness. This can be very costly as well and very bad for the patient's overall health. As for the malpractice, doctors they should test their patient and not just treat them with an online pharmacy without a prescription, which could also be deadly or cause a serious injury

Kiki

When a patient is only seeing two doctors and they are both aware of the drugs the other is prescribing, it is the sole responsibility of those doctors to stop the madness. Stop passing out more drugs without any real answers to their patient's problem.

And doctors do not spend any time with their patients anymore.

I can't go to a doctor without that doctor whipping out his prescription pad while in the meantime, he is talking on the phone to someone else and not even listening to what my problem is.

Then, he calls me uncooperative when I refuse to start down the path of taking fistfuls of drugs.

PTX

I work at a drug rehab, and I hear stories all the time about people getting hooked because their doctors throw all kinds of scripts at them whenever they have the slightest discomfort.

Blobby1

A friend of mine went voluntarily to a Baker Act facility because of too many drugs from "doctors" and that made them even worse? The doctor in the "facility" talked to him for what, 10 minutes, let the other "less functioning" patients scream, disrupt, keep him awake all hours of the night (no sleep = not great for depression btw!) Then the so-called "professional/doctor" who just met him, and saw him for 10 whole minutes threw even more drugs into his system when the prescribed drugs were way over prescribed to begin with > Hence the nonfunctioning leading to the voluntary Baker Act. Now he's out, he's trying to get off the drugs, and of course emotions come up, and now a new therapist says he's non-compliant by not taking the drugs and is threatening to Baker Act him again. For God sake drugs are not always the answer--these places and so-called doctors and laws have way, way too much power over people's lives, and they do not even listen to or know.

Lilly Adams

Right now, many health systems are taking advantage of recent changes to federal regulations and are connecting physicians and hospitals nationwide through Medical Prescription Software. The federal Stark law, which limits the scope of hospital-physician relationships, has been relaxed to enable hospitals and health systems to assist physicians in adopting health-care information technologies, including e-prescribing, to enhance patient safety and quality-of-care.

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