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“Doctor Shopping” After Orthopedic Trauma

“Doctor Shopping” After Orthopedic Trauma

Recent reports have shown that the negative consequences of narcotic use are increasing, and diversion of these drugs for non-medical use is growing, with Americans consuming about 80% of the global opioid supply and 99% of the global hydrocodone supply. There has been an alarming rise in unintentional overdose deaths in the United States over the past decade due largely from increases in prescriptions of narcotics. It has been estimated that up to 20% of prescription drug abusers receive their narcotics from one physician prescriber, but a growing percentage obtain these medications by seeking multiple providers, a phenomenon dubbed “doctor shopping.” Few studies, however, have looked at narcotic use in patients who have experienced orthopedic trauma. While some investigations have focused their attention on positive toxicology screenings at the time of admission after orthopedic trauma, there is limited research exploring the impact of postoperative doctor shopping and the role of orthopedic surgeons in this phenomenon. “It has been suspected that many orthopedic trauma patients may be at a higher risk for pre-injury narcotic use and doctor shopping,” says Hassan R. Mir, MD, MBA, FACS. Exploring the Problem Dr. Mir, Brent J. Morris, MD, and colleagues sought to identify the prevalence of patients who have had orthopedic traumas and were seeking multiple providers for narcotics after surgery in a study published in the Journal of Bone and Joint Surgery. For the analysis, the researchers reviewed prescription records for 151 adults who were admitted to an orthopedic unit over a 1-year period and assessed data on narcotic prescriptions obtained 3 months before and within 6 months after each orthopedic procedure. Patients...
Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Managing Fibromyalgia and Comorbid Depression

Managing Fibromyalgia and Comorbid Depression

About 50% to 70% of fibromyalgia patients have a lifetime history of depression, many of whom take antidepressants to treat their depression. A common clinical question has been how to manage fibromyalgia pain in patients with comorbid depression who are stable on antidepressants. At the 2013 annual meeting of the American College of Rheumatology (ACR), my colleagues and I presented a study that addressed whether pregabalin—an FDA-approved agent for treating fibromyalgia—can help manage pain in patients concurrently taking antidepressants for depression. New Data Our study included 197 adults who met the ACR 1990 criteria for fibromyalgia. Participants had a documented diagnosis of depression, were on a stable dose of an antidepressant, and remained on these drugs throughout the 14-week study. Patients were then started on 150 mg/day of pregabalin, dosed twice daily; this was then optimized to 300 to 450 mg/day, dosed twice daily. The trial used a crossover, double-blind, placebo-controlled design. There were two 6-week periods; patients received pregabalin or placebo, with a 2-week break in between these periods. The average pain severity for patients at the onset of the study was 6.7 out of 10.0 (moderate to severe). Patients on pregabalin had a significant reduction in pain severity when compared with those on placebo. Pain improvement was noted by the first week of treatment and was maintained throughout the study. On average, patients on pregabalin experienced about a 28% reduction in pain severity. The safety profile of pregabalin was consistent with previous fibromyalgia trials and the drug’s current product labeling. Treatment-emergent adverse events were reported by 77.3% of patients on pregabalin and 59.9% for the placebo group. There were four...
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