Professor finds drug screenings scare off patients, lead to addiction
Just this month, President Obama called for $1.1 billion to combat a national epidemic of opioid and heroin addiction.
“Opioid medication prescriptions have been on the rise in the country ever since pain has been treated as a symptom that needs to be treated in and of itself rather than as an underlying problem,” said Partha Krishnamurthy, a UH professor of marketing, director of the Institute for Health Care Marketing and a faculty member at the University of Texas Medical Branch.
Krishnamurthy, like Obama, is committed to understanding this epidemic and contending with it. He co-wrote a study that looks at the effect of urine screenings on patients who have been prescribed opioids.
“Is this mere act of testing neutral in terms of its impact, as is expected, or does it alter behavior?” Krishnamurthy said. “What we found was it dramatically alters behavior.”
The study looked at more than 700 patients and over 4,400 appointments with physicians. According to Krishnamurthy, they found that patient disengagement and the discontinuation of the doctor-patient relationship was increasing, seemingly because of these screenings.
When a patient leaves a clinic for good, it’s not an inconsequential event, especially in the context of opioid medication, Krishnamurthy said.
“What you don’t want is someone who is suffering from pain and plus other things to go out of medical care into the street, and eventually become a statistic,” Krishnamurthy said. “It is not a question of judging people.”
According to Dr. Nora Volkow at the 2014 Senate Caucus on International Narcotics Control, there was an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012.
U.S. prescription opioid overdose deaths have quadrupled since 1999. At the same time, opioid prescriptions have gone up from 76 million in 1991 to 207 million in 2013.
All of this, along with Obama’s recent action, adds up to proof that these drugs are a serious problem, according to Christine Torossian, a psychology sophomore.
“I had a friend whose mom was on an opioid for her back pain,” Torossian said. “She was on it for a few years, and she unintentionally got addicted to it. I think that’s a problem. Especially if it’s prescribed, it’s really easy to get addicted.”
A Variety of Strategies
Obama denied a proposal from the National Governors Association to limit opioid prescriptions, according to Yahoo News.
“If we go to doctors right now and say, ‘don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said during his meeting with the governors on Monday.
“In some cases, addiction is already there.”
The question for many, then, is where should efforts be focused? Where should Obama’s proposed $1.1 billion go?
“The big part of it should go to some kind of awareness (on drug addiction) for the general public,” Torossian said. She believes a lot of people just don’t know how bad the situation is.
As for Krishnamurthy, he and his colleagues are planning out a follow-up study to look more closely at why patients are affected by screenings.
A Compassionate Stance
According to Krishnamurthy, there is an initial, naive viewpoint that because patients sign contracts before being prescribed opioids, they should not be affected when they themselves are subjected to such a test.
He believes that there are four alternative possibilities as to why screenings lack impact.
One, patients actually adhered more to the rules put before them because of the screening.
Two, patients felt that the doctor no longer trusted them, making them uncomfortable.
Three, they went into the appointments with bad intentions, and while they did not act upon those intentions, they felt that they should disengage as to avoid the risk of getting caught in the future.
Or four, they were doing something wrong and against the rules during the process, and either got caught or left for fear of being caught.
“If it is that the person is literally playing games with (the physician), then we might have to look at therapy and counseling and so on,” Krishnamurthy said. “If the person is actually (abusing an) illicit substance, and that’s the reason why they are not engaging, then (the physician’s) investment in the person actually needs to go up.”
Krishnamurthy’s personal takeaway from his study is the importance of this compassionate approach, one that keeps patients in the system and also monitors patient’s decision making.
“There is no question that the biggest gains in health care are likely to come, not because we have now broken new barriers in terms of the science of how nature behaves, but because we have broken barriers in terms of how human beings behave,” Krishnamurthy said. “I don’t say this as criticism of what is not being done, but of opportunity for what can be done.
“The point is this: not all solutions to health care problems are seen under a microscope.”