Critics Say Hospitals Fuel Overprescription of Painkillers

Critics of how prescription painkillers are administered in the U.S. are calling on health officials to phase out hospital procedures and questionnaires used to manage pain.

They say the current system inadvertently encourages the overprescribing of addictive drugs like Vicodin and OxyContin, fueling an epidemic of overdoses tied to the opioid medications. Deaths linked to misuse and abuse of prescription opioids increased to nearly 19,000 in 2014, the highest figure on record, according to the Centers for Disease Control and Prevention.

More than five dozen nonprofit groups and medical experts sent a letter Wednesday to the Joint Commission, a nonprofit agency that accredits U.S. hospitals, asking it to revisit its standards for pain management. Only hospitals that have been accredited can receive payments from government plans like Medicare and Medicaid, making the group’s standards highly influential.

The letter specifically takes issue with guidelines instructing doctors to ask patients to assess their pain.

“The Pain Management Standards foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families and communities,” states the letter, which is co-signed by health commissioners from Vermont, Pennsylvania, Alaska and Rhode Island.

The Chicago-based Joint Commission rejected the idea that its standards push clinicians to prescribe opioids. Instead, the group said its standards require doctors to assess patients for pain and manage it.

“The standards do not require the use of drugs to manage a patient’s pain; and when a drug is appropriate, the standards do not specify which drug should be prescribed,” it said.

The group also stressed that it does not view pain as a “vital sign,” a medical mantra often debated by pain specialists and their critics.

Beginning in the 1990s, pain specialists and patient groups encouraged doctors to treat pain a vital sign that should be routinely monitored, alongside biological measures like body temperature, heart rate and blood pressure.

“All pain was viewed as being bad and so it pushed providers too often to over-prescribe opioids,” said Dr. Michael Carome of the consumer advocacy group Public Citizen, one of the groups signing the letter.

Wednesday’s effort was spearheaded by Physicians for Responsible Opioid Prescribing, which advocates for alternative treatments to opioids, including non-opioid pain relievers, physical therapy and psychotherapy. The group is funded by Phoenix House, a nonprofit chain of addiction treatment centers.

The same coalition filed a petition Wednesday with the federal agency that administers Medicare and Medicaid, the government health programs for the elderly, disabled and poor. The letter asks that officials eliminate certain pain-related questions from patient-satisfaction questionnaires, such as: “During this hospital stay, how often was your pain well controlled?”

The groups argue that such questions inadvertently encourage aggressive use of painkillers to maintain high patient-satisfaction metrics.

“Aggressive management of pain should not be equated with quality health care as it can result in unhelpful and unsafe treatment,” states the petition, which calls on the government to release a proposal for a new questionnaire within 90 days.

Last week a bipartisan group of senators introduced legislation that would eliminate the connection between pain survey questions and the payment rates hospitals receive from Medicare. The bill is sponsored by Senators Joe Manchin, D-W. Va., John Barrasso, R-Wyo., Ron Johnson, R-Wisc., and Richard Blumenthal, D-Conn.