Overprescribing of pain meds still a concern

Fear of being investigated for overprescribing pain medication is taking its toll in Oregon, where a recent poll showed many dying patients spent their last weeks in moderate to severe pain.

In October, a study by Oregon Health Sciences University’s Center for Ethics in Health Care was presented at a statewide conference on end-of-life care. Researchers interviewed 103 families in 1998 whose loved ones had died in the state’s hospitals. The study was prompted by a 1997 study that showed a rise in the number of families who reported that their hospitalized family members spent the last week of their life in "moderate to severe pain." The latest study showed:

• Although 89% of families rated the medical staff’s attention to patient comfort, including pain medication, as "good" or "excellent," 54% said their family members spent the last week of life in "moderate to severe" pain.

• In follow-up interviews with 411 doctors and nurses, researchers found that 96% said "families’ expectations of good pain management are higher than in the past."

• Sixty-six percent of doctors and nurse said "doctors are prescribing less pain medication."

• Fifty-nine percent said "nurses are administering less pain medication."

Most physicians explained that fear of state or federal investigation was a strong reason for limiting pain medication, with fear of media attention and fear of a colleague suspecting assisted suicide listed as lesser concerns, study leader Susan Hickman, PhD, says.