Ignorance Under the Counter

The National Center on Addiction and Substance Abuse (CASA) at Columbia University recently released a report titled, Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.¹ Part of the report evaluated how much education and experience medical doctors receive in prescribing drugs, particularly when it comes to using drugs for pain management. Survey results were categorized based on MDs' experiences in medical school, residency and through continuing education.

In medical schools:

• According to the report, only 55.4% of the MDs surveyed received instruction in prescribing controlled drugs. Of those, 57.6% received only a few hours or less; 34.8% had more than a few hours, but not an entire course.
• Only 47.5% of MDs received instruction in pain management. However, half (51.5%) received only a few hours of instruction or less; 42.1% had more than a few hours, but less than an entire course; and only 5.2% had an entire course.

In residency:

• Only 69.9% of the MDs surveyed received instruction in prescribing controlled drugs, with 42.4% receiving only a few hours or less; 45.3% receiving more than a few hours, but less than an entire course; and only 10.3% receiving an entire course.
• Fewer MDs (61.7%) received some instruction in pain management, with 38.1% receiving a few hours or less; 51% receiving more than a few hours, but less than an entire course; and 9.6% actually taking an entire course.

Continuing medical education (CME):

• Less than half (44.5%) received CME instruction in prescribing controlled drugs, with 32.3% receiving only a few hours or less; 39.9% receiving more than a few hours, but less than an entire course; and 26.4% taking an entire course.
• Only 59.3% of physicians received CME instruction in pain management. 31.3% took a few hours or less; 36.8% took more than a few hours, but less than an entire course; and 30.6% took an entire course.

According to the authors of the report, the following results of their survey demonstrate which sources of information MDs and pharmacists believe are the "most valuable" in gaining knowledge about the drugs they prescribe/dispense. (See table below.)

It should be noted that approximately one out of six MDs and one out of five pharmacists consider information from drug companies as "most valuable."

The investigators pointed out that "[m]uch of physicians' knowledge about new drugs and prescribing trends comes from the Physicians' Desk Reference (PDR) and drug package inserts, which contain information written by pharmaceutical companies about the drugs they manufacture."

They went on to state: "CASA's unprecedented surveys indicate that healthcare practitioners are poorly trained in recognizing and managing addiction and treating pain in patients, that they routinely fail to recognize the signs and symptoms of substance abuse, and that many are uninformed about the laws and regulations surrounding the administration of controlled substances. This may be because many prescriptions for pain and psychiatric medications are written by primary care physicians who typically do not have the specialized training needed for treating pain and psychiatric conditions with controlled drugs."

If you have patients in pain, they should be aware of the risks these drugs pose. And while you are not allowed to tell your patients to discontinue the use of their prescribed drugs, your patients should be encouraged to research the drugs being prescribed for them (or their children), to ask the hard questions, and to not be satisfied with vague answers.

Because what their MD doesn't know can hurt them.

Reference

1. Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. The National Center on Addiction and Substance Abuse at Columbia University, July 2005.

DMP Jr.