Rx Drug Abuse: Doctors Work To Combat Prescription Misuse, Overmedication


Editor’s Note: This article is part of a series produced by the Southwest Times Record in Fort Smith. The remaining articles will be published in The Commercial as space permits. The entire series will be published online at www.pbcommercial.com. Next: Many people do not seek help because of stigma.

FORT SMITH — Doctors are making an effort to correct issues sometimes caused by overprescribing medications.

“The doctors are making a concerted effort to be better educated about how addictive these medications are,” said Paul Smith, a narcotics detective with the Fort Smith Police Department. “They were prescribing quantities that they didn’t realize would addict the patient.”

Physicians who prescribed excessive amounts of pain medications to patients fall into two categories, Smith said.

“There is the group that was a little bit naive about how potent the oxycodone was and a little group that is not as caring about their patients,” Smith said.

Dr. John R. Swicegood with Fort Smith-based Advanced Interventional Pain and Diagnostics is a pain care specialist who has worked to combat the prescription drug misuse and diversion epidemic.

“Unfortunately in our area we have opiate activists who write extraordinary amounts of these drugs,” Swicegood said. “I think there are a lot of people who claim to be pain physicians, but some of the organizations that give pain certification border on being fraudulent.”

Accelerated prescribing of pain medications has led to “gigantic problems,” Swicegood said.

According to U.S. Centers for Disease Control and Prevention research, overdose deaths involving prescription painkillers rose to 16,651 in 2010, accounting for 43 percent of all fatal overdoses.

However, there is a place for pain medications in alleviating pain, according to Swicegood.

“What is very important to communicate is opiates are an important part of pain care. Opiates are not evil,” Swicegood said. “There is a prescribing problem. Unfortunately, you have physicians who prescribe too little and you have physicians who prescribe too much.”

In regard to patients who suffer from cancers that cause severe pain, local oncologists prescribe painkillers appropriately and such drugs are rarely diverted by cancer patients, according to Swicegood, who has co-authored multiple articles in national medical journals, including the article “Opioid Guidelines in the Management of Chronic Non-Cancer Pain.”

“Usually in the cancer population you don’t see a lot of sharing of the drug or selling of the drug,” Swicegood said. “Basically our oncologists do a good job of finding the needs of a cancer patient and administering pain relief medication.”

As with other physicians who prescribe pain medications, oncologists must watch for red flags that the drug is not being diverted, Swicegood said.

“Sometimes you get a situation in which a terminal patient is being cared for by a person who picks up the drugs and diverts them,” he said. “You have to be careful, because these prescription drugs are a very valuable currency.”

Many physicians overmedicate to meet a patient’s desire to be free of pain, Smith said.

“The reality is when you go to the doctor you want to get better and there is a limited amount the doctor can do to treat you, and to overcompensate for that they may overmedicate,” he said.

Physicians should emphasize healthy living when treating patients who suffer from pain rather than overprescribing pain medication, he said.

“The treatment of pain is a multi-discipline field,” Swicegood said. “It really goes back to prescribing responsibly and monitoring and the patient being proactive in their own health.”

Wellness is a key part of safely reducing pain, Swicegood said, and more physicians should emphasize wellness to their patients.

“Wellness is not smoking, very modest alcohol intake, weight control, exercise and diet,” Swicegood said.

Around four or five years ago, local narcotics officers began noticing that doctors were overprescribing medication.

“When it became a problem, we started to educate the doctors,” Smith said. “When they became self-aware, they started to try and control it a little better.”