If a patient is a drug-seeker, you're not going to cure him during the hospital stay; unless you're working acute rehab. In spite of addiction/dependence, you can't not treat a patient's pain. The fact that he/she may be addicted doesn't negate the fact that he may be in real pain. That's what pain service is for. Many of the pt's who were drug seeking were actually reluctant to deal with a pain service consult because we were giving out "better stuff" in the hospital.
As for the kids overdosing on fentanyl or being sold oxycontin, it's not because of prescriptions being handed out. Most of them who have used it have taken it from mom or dad without their knowledge. It's not the doc's responsibility if the parents don't keep it locked up. So many people subscribe to the "my kid would never do that" mentality or "I don't want Johnny to think that I don't trust him, it would damage his self-esteem
" school of thought, that it's not hard to see how they can gain access to those meds. And the ones sold on the street, many, if not most, aren't legally obtained in the first place. So should the rest of society be punished for the illegal acts of others?
One solution that I have mixed feelings about is keeping a database to prevent polypharmacy for narcotics and other meds as well. It would cut into the doctor, ED, pharmacy shopping to get more scripts. On the other hand, what kind of slippery slope would it start? Could I be prevented from getting a second opinion if one doc wasn't treating my pain? Do I want use of certain meds to be public knowledge? A lot of the information could be prejudicial. Hmmm . . . .