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The answering service calls a doctor at midnight. The message is that Mr. Smith has run out of pain medication and would like another prescription.

As her half-awake mind begins to try to remember when the patient had surgery, and how many pain pills she had prescribed, the physician realizes the choice boils down to whether she wants to evaluate the patient’s pain over the phone (a challenging task without the patient’s medical record available) or call in a refill.

She calls in a new prescription.

A pharmacist receives the refill request for the same patient, and notes that this patient has received narcotics from several other physicians in the last six months. He makes a mental note to talk with the patient about his pain and refills when he comes in to pick up the prescription, but knowing the patient recently had surgery, and that the physician has authorized the refill, the pharmacist processes the request.

Adequate treatment of pain has been a focus for health care professionals for several decades. Physicians, pharmacists and nurses ask patients to rate their pain levels in both inpatient and outpatient settings. With the release of newer and, presumably, safer drugs such as Oxycontin, the hope was that patients would not have to tolerate acute and chronic pain.

Unfortunately, the prescription drug abuse problem has now become a national crisis. Media reports come out daily about individuals who have lost everything due to an addiction to prescription drugs. A recent report from JAMA Psychiatry points out that more than 75 percent of current heroin users started with the abuse of prescription drugs. Moreover, heroin use, which was once linked with urban poverty, has taken root in the suburbs. And the cause lies with prescription narcotic abuse; as the medications become too expensive, people resort to heroin.

The cause of the epidemic is multifaceted. Unfortunately, it begins with people trying to do the right thing by helping patients manage their pain. We believe that several steps can be taken to mitigate this problem:

■ Physicians need to be sparing when prescribing narcotics. If a patient has an acute episode of pain, a limited number of narcotics should be prescribed.

■ Specialists should always communicate with a primary care physician to assure that a patient is not receiving multiple sources of narcotics.

■ Physicians should be quick to refer patients to substance abuse specialists or clinics rather than trying to wean patients off narcotics themselves.

■ Pharmacists are in the ideal position to monitor potential narcotic abuse. Physicians should welcome their interventions and advice.

■ Both physicians and pharmacists often have access to state prescription monitoring systems that track narcotics dispensed from different pharmacies and physicians. State governments should ensure these systems are easy to use, with real-time reporting available.

The only way that we can truly make a difference, however, is changing the public perception of prescription narcotics. Patients have to understand that, like any other medication, there are risks with the potential benefits — the major one being addiction. Parents will have to take steps from leaving these drugs in readily accessible locations; the overwhelming majority of high school seniors state that they first gained access to prescription drugs from friends or relatives.

Finally, patients will need to understand that a health professional’s reticence to prescribe narcotics is not a sign of callousness, but rather a sign of vigilance to prevent a potentially worse outcome than pain.

Dr. Vik Reddy is medical director of quality and clinical integration at Henry Ford Macomb Hospital.

Nadia Haque is an administrative fellow with the Henry Ford Medical Group.

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