Speak Out: What's your opinion on stricter regulation of prescribing painkillers, including mandatory referrals?

When I go to conferences, I hear about doctors being educated to use these drugs more liberally and to treat pain without being so concerned about the bias of addiction.

I haven't heard that it's that much of a problem in terms of people being harmed by prescription pain killers, so I don't see these efforts going anywhere."

But if you add these kinds of requirements for doctors who have been out 10 years, I think a lot of it would be pushed along to the patients. Doctors will say they're not allowed to prescribe pain medications and send patients to the emergency room or a pain specialist.

It's very hard when you start dealing with people with legitimate pain, like renal colic. We deal with chronic pain patients, and we know patients who are malingering and those who aren't. Pharmacists here are also very good at alerting us to patients filling multiple scripts.

If a patient reaches the point of needing really heavy narcotics and it gets beyond my comfort level, I refer on to a pain control specialist, but to make that a requirement would be onerous for the patient and for a physician trying to provide care in a timely manner. Referring a patient may mean another wait for an appointment and another co-pay when people are already delaying care as long as they can."

Geoff Ledgerwood, MD
Denver

If I'm uncomfortable with the amount of opioids I'm prescribing, I will refer the patient to a pain management specialist. But to make it an absolute rule adds more limitations, headaches, and potential problems for both the doctor and the patient.

An opioid-intolerant patient who has a 4-mm stone may need more opioids, but if a hard and fast cut-off is triggered, that could change the patient's care path.

You're always going to have medication seekers, and additional training won't affect whether you think about that. Recommending additional training may be a more effective way to go than forcing the issue."

Gilbert P. Klemann, MD
Portland, OR

"If it's urologic pain, urologists are well-versed in dealing with that. We don't need additional training to deal with urologic pain.

Neuropathic pain is different, and rather than having additional training, I would seek out a pain management specialist or a neurologist.

Doctors should be able to recognize addicts, and pharmacies will let you know, too.

Within the purview of one's training, it's up to the individual to know what their own bounds are. Additional regulation isn't the answer."

Robert Schlesinger, MD
Stroughton, MA