Prescribing Habits

        Do we have an over-prescribing problem in modern medicine?  Is our entire culture now centered around providing patients with medications rather than treating them? 

        Those are the kinds of questions I thought to myself after running across a question directed to me from the social media world.  I’m just not sure if I have any definitive answers. 

        I was asked to comment about the decision to make the new stand alone hydrocodone product a class C-II drug.  That classification would carry with it the associated restrictions and implicit dangers associated with other medications in the class. 

        My admittedly snarky response was along the lines of “would it matter?”  The implication here is that our controlled medication classification system has been reduced in meaningfulness. 

        Haven’t we arrived at a point as a nation where controlled substances are over-prescribed?  Look at the widespread abuse of these medications.  Prescription drug addiction is commonplace now in no small part due to ease of access.   

        And yes, I fully recognize that prescribers do not carry the full blame for any drug abuse epidemic.  Other healthcare providers, including pharmacists, can be part of the problem as well. 

        But if we all can make the assumption that prescribing habits don’t meaningfully change based on the class of a medication, wouldn’t that at least partially invalidate it?  Shouldn’t the addictive properties of a particular medication be a consideration for prescribers? 

        Pharmacists are the distributors of all prescriptions including controlled substances.  But doctors and other prescribers are still a patient’s gateway for access to those substances.  These medications all still require a valid prescription.

        My point is that to classify plain hydrocodone or any other legend drug as a C-II and have it mean something, you need responsible prescribers.   Giving narcotics or other controlled substances to anyone with a minor ache or pain is not practicing medicine. 

        I think medical schools need to spend extra time training future doctors on the appropriate use of drugs.  While we don’t want to deny anyone from legitimate access, we also don’t want to feed our society’s abuse problem by over-prescribing. 

        I’m worried that making a drug like plain hydrocodone a C-II will only create needless hassles and rules for legitimate patients and pharmacists.  At the same time, the problem prescribers will continue to freely write for these types of medications. 

        Modern medicine is cutting edge.  But there is a downside to all of these powerful compounds. 

         Drugs can be addictive and potentially harmful.   We must not forget that as we distribute medications to patients.   Isn’t do no harm still the first rule of medicine? 

         Prescribing habits impact the availability of prescription medications.  Prescribers must be aware that anything classified as a C-II should be used with extreme caution.    Unfortunately, that doesn’t always seem to be the case.

The Redheaded Pharmacist

2 Comments to “Prescribing Habits”

  1. By pharmaciststeve, February 9, 2013 @ 9:28 pm

    Here is a recently published article on addiction… and it is not all about just drugs


  2. By Crazy RxMan, February 10, 2013 @ 3:31 pm

    In my posh, upper middle class neighborhood, we generally fill five times as many CII prescriptions compared to other stores in our chain. And it appears that the “word is out” on the streets that we stock more than other stores too as people flock to us from all around town too because we have it in stock. So I’ve witnesses exactly what you’re talking about… it does appear to be a real problem TO ME.

    What especially adds to the problem is that we have several prescribers that hand out prescriptions for 30 day supplies of CII meds EVERY three weeks! It drives me crazy.


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