An increase in opioid overdose deaths and a move by many states to limit prescriptions of opioids—along with a
draft proposal of regulations released this week by the
Centers for Disease Control and Prevention to reduce use of the drugs—is putting small town doctors in the unenviable position of refusing to prescribe painkillers to patients who actually need them, Jan Hoffman reports for
The New York Times. According to a
recent study in
JAMA Internal Medicine, 15.3 million painkiller prescriptions were for Medicare patients alone in 2013. A
Stateline study found that the largest number of
painkiller prescriptions are in the South, led by Alabama, where 142.9
prescriptions are given for every 100 people. A
CDC study from December found that rural areas—where opoid use and overdoses are on the rise—lack prevention services for opiate addiction.
In Nebraska, Medicaid patients "may face limits this year that have been recommended by a state drug review board," Hoffman writes. Dr. Robert L. Wergin, the only physician in rural Milford, Neb.,
(City-Data map) told Hoffman, “I have a patient with inoperable spinal stenosis who needs to be able to keep chopping wood to heat his home. A one-size-fits-all prescription algorithm just doesn’t fit him. But I have to comply.”
Wergin, who is also chairman of the board of the
American Academy of Family Physicians, is taking professional and personal risks when he prescribes opioids, Hoffman writes. "He must go through an elaborate prescription checklist, with state and federal officials looking over his shoulder. He has faced threats from addicts who show up at the hospital emergency room, desperate for pills. Following the recommendation of his malpractice insurance carrier, he now requires his patients to sign 'pain management contracts,' in which they must agree to random drug tests before receiving an opioid prescription."
"The new vigilance has injected an uncomfortable layer of suspicion in his relationships with" patients, some of whom he has known since grade school, Hoffman writes. And if patients want to see another doctor—one they don't know personally—there are not many alternatives, with the closest city to Milford 30 miles away in Lincoln. (
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