The Ethics of Prescription Drugs: Playing With Fire?

The ethical prescription of drugs, especially those that have a high risk of forming a dependency, is more important today than ever before. The opioid epidemic sweeping across the United States did not happen overnight, and in fact happened under current legal regulatory and prescription guidelines that doctors, FNPs, and pharmacists must adhere to.

Those who are prescribing these potentially addictive and dangerous drugs to patients need to exercise more caution before writing these prescriptions in order to uphold one of the most important tenets of the Hippocratic Oath: to first, do no harm.

Prescribing Ethically

Healthcare professionals often face ethical and legal issues when it comes to prescribing medicine to a patient in need. Ensuring that a patient fully understands their condition, all available treatment options, and what side effects those various treatment options might cause is of utmost importance.

Even when a patient has given informed consent in regards to prescribed medication, they might not fully understand the implications of addiction to a prescribed substance, and while the CDC does provide guidelines for prescribing addictive medication like opioids, it isn’t always easy for a prescribing physician to recognize whether a patient will be at risk of developing an addiction.

In cases where potentially addictive drugs are prescribed, it is important that vigorous follow-ups are implemented to mitigate possible substance abuse. Family nurse practitioners are often on the front lines of the debate of ethical prescription of medication, because they often maintain close relationships with their patients, which can lead to ethically tricky situations for them. When FNPs prescribe medication to family or friends, it can actually trigger legality issues, and depending on where they practice doing so may be unconditionally illegal. This is why many physicians and FNPs outright refuse to treat or prescribe to close friends or family.

The relationship between ethics and law is complex, and while some conduct is legally permissible, it can be ethically dubious or unacceptable. The reversal of this situation can be just as common, wherein what is the obvious ethical choice may be illegal. Maintaining this balancing act when prescribing medications is just one instance where conflict of ethics and legality can occur.

Prescription Drug Abuse Is Rampant

Prescription drug abuse is no joking matter in the United States, and while many patients may convince themselves that since their drug of choice is prescribed to them it can’t be that dangerous, they often find themselves struggling with a dangerous addiction that they never expected. Many prescription drugs are incredibly dangerous, which is one of the reasons someone needs a prescription for them in the first place. Though the opioid epidemic is the most widely covered prescription drug abuse issue, other drugs like Ambien, hormonal birth control, and even SSRIs used to treat a wide variety of psychological disorders can be dangerous and even deadly if abused or taken improperly.

In the 1990s, the weight loss drug combination Fen-Phen was widely prescribed by ethically compromised physicians and abused by patients across the US. One of the drugs in the combination, phentermine, is a type of amphetamine that is not only addictive but dangerous as well. Most modern weight-loss drugs are relatively safe in comparison as the majority of them either block your body from absorbing fat, or reduce cravings for food by targeting the part of the brain that controls appetite.

However, weight-loss drugs are inherently risky for potential abuse, as many patients can find themselves abusing these drugs if they don’t see the results they expect. Additionally, there are still weight-loss drugs on the market that contain phentermine, which ups the risk of abuse significantly.

Those who are suffering from opioid dependency due to prescription medication are also at high risk of developing mental disorders, have an increased risk of infection if injecting drugs, and have a greater chance of relapse due to the availability of prescription drugs. While quick detoxification is possible and these patients’ lives can be turned around with the right help, their prescribing physician might have been able to prevent their addiction from ever forming by approaching their treatment more ethically, and getting them off opioids at the first sign of drug-seeking behavior.

However, doctors cannot read minds, nor can they dictate what a patient does after they are prescribed any given medication, leaving the decision of whether or not to prescribe opioids an ethical gray area.

Encouraging Alternatives

Unfortunately, for many suffering from chronic pain prescription drugs can seem like the only treatment option that is effective. While it is true that opioids are highly effective at managing chronic pain, they are far from the only option available to patients looking for relief.

Prescribing physicians should try their best to encourage lifestyle changes like cognitive-behavioral therapy in conjunction with physical training or regular therapeutic exercise which can also be an effective way to manage chronic pain. This method, however, is always going to be more difficult than simply getting a prescription for a painkiller.

Encouraging patients to take care of their preventive health effectively side-steps the need for many prescription drugs by avoiding the illnesses that require them in the first place. When patients maintain their health, they don’t have to wait for a drug to be formulated or depend on various delivery systems because they won’t need any medication in the first place. In a perfect world, preventive health measures would keep patients happy and healthy throughout their lifetimes, but life is unpredictable and there is no way to control outside forces that may negatively impact overall health.

In the court of public opinion, a safer alternative to opioids is in high demand. Currently well over half of the states in the United States have cannabinoids legalized in some form or another as a treatment for a host of ailments. Additionally, kratom, a plant in the coffee family, has also garnered significant support as an opioid alternative from patients who swear by its analgesic effects. With the pharmacology of kratom is being explored further, the FDA has yet to say whether or not they endorse it as a natural pain reliever.

The ethics of prescribing medications to patients is complex, and can lead to a political and legal minefield if not properly handled. At this point in time, since there is no legislation in the works to change the order of things, both patient and prescriber alike should exercise extreme caution with addictive medications, attempt to maintain their health through preventative measures, and explore alternative options before they rely on a pill to fix their problems.