Corey Haim and Doctor Shopping

Corey Haim’s tragic death recently highlighted an epidemic problem our country faces with prescription drugs.  The question I hear repeatedly is “How could a doctor prescribe powerful pain killers and other sedatives to a person who is clearly abusing them?”
Well, the answer is as multifaceted as this unfortunate young actor’s career and life.  Doctors do not want to contribute to an addiction, but when we encounter a patient with chronic pain we find ourselves in murky waters.  In the emergency department, patients frequently ask for pain medications because their chronic pain has “become much worse,” or they reinjured something.  They might complain of an area of new pain, or there may be no available history whatsoever, so the doctor may not know that the patient has chronic pain at all.  When I am unsure  about a patient’s history and whether they are simply “doctor shopping,” for pills, I am faced with the following dilemma:  Do I prescribe pain medications and risk contributing to an addiction, or even a potential overdose?  Or do I deny the medications and risk leaving a patient suffering in pain?  In the short time I have to make this decision, I try to play detective and sort out whether the patient is being truthful with me.  To say that this strains the doctor/patient relationship is a gross understatement.  No physician wants to accuse a patient of dishonesty, and no patient wants to feel that they are being judged.  It is no coincidence that a common complaint among patients is that “the doctor thought I was a drug addict.”
Superimposed on this prickly problem is the fear that the patient will complain to the hospital, or even threaten legal action.  I’ve actually had patients become physically violent when the desired prescription is not forthcoming.  Unfortunately, the prescription drug problem has blossomed during the last 10 years, becoming a daily battle waged in our nation’s emergency departments and doctor’s offices.  Perhaps the one positive result from Corey Haim’s death could be a greater understanding of prescription drug abuse, and the motivation to stop it.