Today Art Caplan, in his MSNBC column, discusses the epidemic of prescription drug abuse in this country. But his conclusions would have a chilling effect upon physicians. He concludes, “Shouldn’t we create a public policy and legal doctrine that hold accountable those doctors who prescribe these potent painkillers indiscriminately? Of course we should. The problem, of course, is that creating policy that is designed to catch the “bad apples” in medicine so far in the US has had the effect of treating every physician who prescribes opioids and other pain medication in the US like they are a criminal. Prescription monitoring programs (PMPs) in 40 states haven’t resulted in any positive outcomes and have made doctors afraid to prescribe for fear of being part of a “bad doctor” database. Pharmacies have also tried to control access to prescription drugs but the result has been “blacklists” of physicians who prescribe and the refusal by some pharmacies, such as CVS in Florida, to fill the prescriptions of opioid prescribers.

The key to balanced pain policy is to keep separate the problem of prescription drug abuse from the problem of the lack of quality pain management in the US.

As Caplan says “It is long past time to…hold doctors accountable for the damage they do in misprescribing…” Agreed. But how we do that will make all the difference between denying those with legitimate medical issues adequate care and cracking down indiscriminately on all pain prescribers in such a way that no one can be adequately cared for. No one, as of yet, has found the way to solve this puzzle.

In general, Caplan’s sentiment is correct. But what is lacking is any concrete proposal for how we can find the balance between catching the bad apples without punishing the patients and physicians who are simply trying to receive or deliver quality pain care.

Summer Johnson McGee, PhD