We tend to think of health crises as something to which the U.S. health care system only responds, such as a sudden uptick in infections like Zika or Ebola. But sometimes there are crises for which the system itself bears some responsibility in the first place, often because of the way it addresses another problem. From an effort to address under-treatment of pain, the outcome has been doctors and hospitals over-prescribing painkillers — which in turn has seriously contributed to the growing opioid epidemic in this country, and the tragic deaths that follow in its wake.
Naturally, hospitals should be concerned that their patients are not in excessive pain after surgery. But there is another reason that hospitals may err on the side of over-prescribing opioids: patient satisfaction scores. Hospitals with low patient satisfaction scores may lose revenue, including payments tied directly to these scores. The surveys patients receive in the days and weeks after surgery, on which patient satisfaction scores are based, typically ask questions about how well hospital staff responded to the patient's pain.
If the patient's recollection of being in the hospital includes asking for help with pain, and not feeling as if they got adequate relief, they may respond unfavorably to patient surveys or even make complaints about their treatment. Hospitals are eager to avoid the taint of patient dissatisfaction. Not wishing to appear as if they poorly manage patient pain, hospitals and doctors may instead over-manage it. Patients may not be aware of the implications of taking all the medicine that has been prescribed for them. By the time they learn, they may already be on the road to addiction.
Whether a patient develops an addiction after a hospital stay may have a great deal to do with how his or her physician prescribes pain medication for use after discharge. Many people go into the hospital for a fairly routine procedure, such as an elective laparoscopic cholecystectomy. Some post-operative pain is typical, but this can often be successfully managed with either non-opioid pain relievers, or a very limited number of opioid tablets (five or fewer) in combination with non-opioid medications.
Patient needs vary, so what could be a reasonable dosage for one patient could be far too much or too little for another. To avoid failing to manage patients' pain, a doctor may tend toward offering too much medicine. A study published by the Journal of the American Medical Association found that between 67 and 92 percent of patients reported unused opioids after common surgical procedures (and rates of safe storage or disposal for these were low.)
Some doctors over-prescribe opioids as a matter of course, perhaps giving patients a prescription for 30 days' worth of opioid tablets, sometimes with a refill. This course of medication is not only unnecessary but can be highly addictive. Oxycodone is the most frequently prescribed, with a typical instruction to take 5-10 mg of the medication every four to six hours as needed for pain. A dutiful patient, wishing to avoid pain, might take the full course of medication, believing he needs to comply with his doctor's orders. But this dosage could lead to addiction.
When the prescription runs out, if a patient simply goes from taking the "recommended" dosage to none at all, he could experience severe withdrawal symptoms. If he seeks treatment for the nausea, vomiting, muscle pain, headaches and low-grade fever often associated with withdrawal, many doctors may assume a virus and fail to treat for withdrawal symptoms.
Of course, suffering through unpleasant withdrawal symptoms is far from the worst thing that can happen. Patients may continue to use prescription opioids if they are available, concluding that the relief they provide justifies their continued use. When they are no longer able to access or afford prescription opioids, they may turn to street drugs like heroin. This is far from uncommon; a majority of heroin users report that they switched to the street drug after prescription opioids became too costly.
In light of all of the above, many medical professionals are beginning to consider whether opioid addiction that forms after a hospital stay can be considered a medical error, like a hospital-acquired staph infection that a patient picked up because hospital staff failed to follow hygiene procedures.
There is reason to classify opioid addiction in this way. Doctors studying the matter have observed that the condition begins or arises during hospitalization; it is both high-cost and high volume; and perhaps most importantly, opioid addiction could reasonably be prevented if evidence-based guidelines are applied. In fact, a study of surgical records for over 200,000 patients indicated that the ideal length of treatment with opioids for general surgical procedures is four to nine days; for women's health procedures, four to thirteen days; and for musculoskeletal procedures, six to fifteen days.
There is a growing belief that failure to appropriately prescribe opioids could be medical malpractice, especially when patients are not adequately warned of the risk of addiction and overdose (about 40% of opioid overdoses are from prescription drugs). And, of course, these issues do not only affect the addict or victim. Hospitals over-prescribing painkillers may devastate whole families, emotionally and financially.
The costs of opioid addiction are very real and can affect anyone. In 2016, the last year for which data is available, 46 people died every day from opioid addiction. The overdose rate was highest among those between the ages of 25 and 54. If you or someone you loved became addicted to opioids, or overdosed on them, following a hospital stay or surgery, you should consider consulting with an experienced Oregon medical malpractice attorney. While nothing can erase the ravages of addiction and loss, filing a claim, when warranted, can help ease financial pressures and hold the medical system to account for the actions that contribute to addiction. We invite you to contact our law office if you have any questions about the role your medical provider may have played in the development of an addiction or overdose.
Our office has experience in Oregon and Washington with these difficult and tragic cases. If you or a loved one has been injured, please feel free to contact our office.
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