05.14
Aak
Unfortunately, once the drugs are licensed, the regulators take their foot off the gas. There are systems for doctors to report unexpected effects in the day-to-day use of all drugs and devices but few reports are filed. The reasons for this failure are complicated. At their heart, the influence of the manufacturers is clear. Profits would be at risk if there was a consistent stream of news showing any drug was unsafe. When millions of dollars have been invested in getting the drug to market, doctors must look the other way. This is encouraged by financial and other incentives. It's only when people die that there are statistics for the regulators to look at.
This would be wonderful except it depends on the autopsy system to accurately identify cause of death and then honestly report it. Too often, deaths are considered "routine" and little effort is made to find anything to disturb the calm. Indeed, in many cases, evidence of medical malpractice ends up six feet under. The medical profession looks after its own. The one area where coroners tend to be honest is in reporting deaths through prescription-drug overdoses. This is not seen as threatening the profits of the manufacturers or the professional standing of the doctors. Perhaps it's not surprising that, given our country takes more drugs per head of population than any other country, we also have a rising tide of deaths through overdoses.
Washington state decided to take action and has published some tough new rules due to come into force on January 1, 2012. This is a complete reversal of policy. Back in the 1980's, studies suggested our doctors were failing to offer effective support to those in pain. Doctors responded by prescribing painkillers in increasing numbers. Medical boards smiled reassuringly and said they would not penalize doctors who prescribed drugs to relieve pain. Sadly, as opiate drug use grew, so did the number of deaths. This liberal regime is going to end.
Doctors are now preparing for the new procedures. This requires a detailed consideration of every patient's records to decide whether continuing to prescribe opiates is justified. Interestingly, many patients are now being cut off from supplies. Desperate people in pain are now flooding into clinics and hospitals. This is not what was expected. Even more interesting is the refusal of the medical board to reconsider the regulations. They did what the politicians required. Now it's left to the politicians to deal with the fallout.
Problems with Tramadol prescriptions
There's already evidence that there's abuse of over-the-counter painkillers as people denied access to opiates try to find alternates. Inevitably, Tramadol has been caught up in the confusion. Hospitals and clinics are refusing to take on new patients for medium- to long-term pain management. This denies patients access to Tramadol even though it has an unblemished track record of safety. Hopefully, this situation will be resolved in Washington and will also serve as a warning of the chaos if prescribing rules are changed without thinking through the consequences.
