What should physicians do about the opioid crisis?

Gary LeRoy, MD, dreads the early-morning phone call from the coroner’s office-the one where he learns that a patient who has been taking opioids has died in his sleep.

 

Further reading: Physicians don't want hands tied by opioid reform

 

LeRoy, a family practitioner in Dayton, Ohio, prescribes opioids carefully. He orders them only in small quantities and for limited periods, and instructs patients in how to use them. But patients don’t always tell him what medications they are getting from other prescribers. Nor can he stop them from getting drugs from friends and family members, or buying them on the street.

The result, if the drugs are used in the wrong combination, is the notification from the coroner. “That kind of call really gnaws at you,” he says. 

Experts agree opioid use in the U.S. is out of control-and primary care doctors are writing most of the prescriptions. A study of 2013 Medicare Part D claims found that internists and family practitioners accounted for over half of the 54.5 million prescriptions written for Schedule II opioids that year. 

Like LeRoy, most primary care doctors take their prescribing responsibilities seriously. Indeed, 84% say they are “very” or “moderately” concerned about the possibility of opioid addiction among their patients, and 80% about the possibility of death, according to a 2015 survey. 

 

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Yet as the main providers of healthcare to most Americans, primary care doctors are who patients turn to first when seeking relief from pain. The question now is, how do primary care providers become part of the solution? How do they minimize the number of opioids they dispense and reduce the number of people dependent on them, while still helping to ease the chronic pain millions of Americans experience?

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