Prescribing Narcotics for Dental Pain

It really hit me this week at 2:30am on Wednesday morning. A patient of ours was out of the area and in severe dental pain so he got in touch with me through our emergency phone system. He was looking for pain relief so he could get some sleep and then get back into West Chester to be treated the following day. (I know him well and he was not seeking drugs for recreational use.) I was unable to call in a prescription for him. It may come as news to some of you that prescribers are no longer able to just call in a prescription for a narcotic to a pharmacy as we have done for many decades. It was at that moment that I realized how much I have truly been affected by the greed of a few “bad” doctors who got rich off of illegally writing prescriptions for millions and millions of narcotics for patients that did not need them for pain.

Here is how the scheme worked:

The “patient” would come into the nefarious physician or dentist office, pay them $100 for a bogus exam (in which they were never seen) and then the practitioner would write the narcotic prescription for as many pills as would not cause suspicion. The patient would then fill the prescription, sell the lucrative drugs on the streets or to middlemen who would distribute them for a very tidy profit. Repeat for both parties until rich. Pennsylvania (and 10 other state) developed a unique answer to try and stop these prescribers from pursuing their evil ways. And that answer is: require honest, law-abiding pain-reliever prescribers, like Dr. Ryan and I, to have to go onto Pennsylvania’s drug prescription website and perform a search for each person to whom we will be prescribing the narcotic. If the patient has a clean drug record and does not have an active narcotic prescriptio, we have to write a prescription for the medication and the patient would have to go and have the prescription filled. The patient and the prescriber are then monitored to make sure that any future prescriptions are not so frequent as to cause suspicion.

In a day and age where we are able to monitor every move of just about anyone in the United States and abroad via mobile devices and social media, we have reverted back to paper, a pen or printer, and a drive to the local pharmacy. We have advanced technology at our disposal and yet we cannot come up with a better way to get medication to patients in need.The answer is not disallowing dentists and physicians from prescribing by phone (which we absolutely have/had to do from time to time) but rather monitoring every DEA license-holder for how many narcotics they are prescribing and holding them accountable on a daily, weekly, monthly and annual basis. The prescriber cannot get drugs to patients without either purchasing them or having the pharmacy distribute them so this is very easily checked. Our pharmacies have advances computer systems that can easily handle this monitoring process. If there is suspicion, the authorities are alerted and their drug-prescribing privileges and suspended pending an investigation. I think that there is a good reason why only 1 in 5 states have elected to control prescribers ability to treat pain patients. I just hope that Pennsylvania someday opens their collective eyes and sees what the other 39 states found to be a poor way to handle a growing epidemic.