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Federal Government Must Do More to Track Opioid Overprescribers

Experts agree that one of the best ways to tackle the growing opioid crisis is to crack down on opioid overprescribers. Unfortunately, a new report suggests that the federal government is not doing a good job at determining who those doctors are.

Pain Prescriptions Fueling Opioid Addiction

As we have previously discussed on this San Diego Injury Blog, several factors have contributed to the rapid increase in opioid-related overdoses, including a rise in prescriptions for the potent painkillers. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled. However, there has not been an overall change in the amount of pain that Americans report.

In 2013, providers wrote nearly a quarter of a billion opioid prescriptions, which is enough for every American adult to have their own bottle of pills. Opioids are also increasingly prescribed for chronic pain. Although they may provide short-term relief, the medications have not proven to be an effective long-term solution.

New GAO Report on Opioid abuse

In a new report, the Government Accountability Office (GAO) concluded that the Centers for Medicare & Medicaid Services (CMS) need to gather more overprescribing data from payers and providers to identify potential opioid risks.

“We found that CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers,” the GAO report states. “As a result, CMS is lacking information that it could use to assess how opioid prescribing patterns are changing over time, and whether its efforts to reduce harm are effective.”

The GAO report notes that CMS’s existing data effectively identified more than 33,000 Medicare beneficiaries at risk for opioid abuse. However, it concludes that the existing criteria CMS uses to detect possible opioid abuse fails to capture all of the risk indicators set forth in guidelines developed by the Centers for Disease Control and Prevention (CDC).

“Because neither the CMS criteria nor the patient safety measures include all beneficiaries potentially at risk of harm from high opioid doses, we recommended that CMS should gather information over time on the total number of beneficiaries who receive high opioid morphine equivalent doses regardless of the number of pharmacies or providers, as part of assessing progress over time in reaching the agency’s goals related to reducing opioid use,” the GAO said.

Holding Negligent Prescribers Accountable

While there is nothing unethical or negligent about prescribing opioid medications to help patients manage pain, medical professionals have a legal obligation that their treatment of a patient and their prescription practices are performed in accordance with the acceptable standard of care. That means that doctors must carefully evaluate a patient’s health, as well as the risks and benefits of any prescribed narcotics. In some cases, the failure to weigh the benefits of pain treatment with the risk of addiction can rise to the level of medical malpractice.

To prove medical malpractice, the plaintiff must be able to show that the physician breached the duty of care. To determine what a "reasonably prudent physician" would have done in the same situation, courts often look to whether the doctor followed relevant opioid-prescribing guidelines. For instance, the CDC Guidelines for Prescribing Opioids for Chronic Pain state that doctors should discuss the risks of opioids directly with patients and reevaluate patients every three months to assess for risks in relation to benefits. Courts may also find negligence when doctors fail to maintain accurate records of opioids prescribed and fail to take any action to limit opioid prescriptions for known-addicted patients.

If you or someone you care about has suffered serious harm due to negligent prescriber, you may be entitled to compensation, such as pain and suffering damages and reimbursement of medical expenses. For more information, please contact a San Diego medical malpractice lawyer at the Law Offices of Robert Vaage for a free consultation.