Undertrained Doctors, Overprescribed Drugs
When doctors prescribe medicine, more than just their patients count on them to get it right. Society as a whole has an interest in keeping certain drugs under control -- and the evidence shows that when it comes to opioid pain relievers and antibiotics, some doctors are failing to do so.
Too many prescribe drugs that aren’t needed, prescribe more than is necessary, or (in the case of opioids) neglect signs of abuse. More training could improve physicians’ performance, but it’s already available and too few doctors take advantage of it. What’s the best way to get more of them to sign up?
Start with opioids. Some 20,000 Americans are dying every year from opioid overdose; an estimated 2 million more have become addicted. Yet in 2014, doctors wrote almost 200 million prescriptions, enough for opioids to be taken by every adult in the country.
Doctors say they don’t need any extra training, but the evidence suggests otherwise. In follow-up surveys, those who received training were more likely to correctly answer questions about how to prescribe opioids safely, and were more likely to report following those guidelines with their patients.
The Food and Drug Administration has required drugmakers to offer opioid-prescriber training courses. But so far only a small fraction of the country’s 320,000 active opioid prescribers have signed up. The FDA hoped at least 80,000 would complete the three-hour online course within two years, yet fewer than 38,000 did. Now the FDA is considering making the training mandatory as a condition for prescribing the drugs, and awaits a ruling from an expert panel this week on whether to go ahead.
Doctors as a group have shown themselves to be less than responsible about prescribing antibiotics, as well. A recent study found that at least 30 percent of antibiotics prescriptions written in outpatient settings are unnecessary. For sinusitis and other acute respiratory conditions, half of antibiotic prescriptions are uncalled for.
Such overprescribing enables disease germs to become resistant to drugs, leading to the kind of intractable infections that kill 23,000 people annually in the U.S.
Research suggests that, here too, doctor education could help. In one study, a single hour-long tutoring session, followed by quarterly feedback, reduced inappropriate antibiotics prescribing by 13 percent.
Doctors say they resent government interference in the practice of medicine -- but more training would benefit doctors and society alike. Perhaps incentives can be designed to get more doctors to sign up. If not, training may have to be mandatory. One way or another, doctors need to set aside the time to learn how to better perform this essential part of their jobs.
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