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Doctors’ concerns about receiving negative reviews on consumer ratings websites may influence their decision to write opioid prescriptions for patients who request them, according to an opinion piece in this week’s New England Journal of Medicine.

Physicians are relying more on patients’ self-reports of pain than in the past, and the “treatment of pain is held up as the holy grail of compassionate medical care,” Anna Lembke, M.D., of Stanford University, wrote.

Lembke points out that the American attitude that “all suffering is avoidable” has increased demand for treatment, MedPageToday notes. She adds that treating pain can be profitable, while treating addiction is not. Counseling, a critical part of addiction treatment, is time-consuming, and is not adequately reimbursed.

Lembke suggests that all doctors should be required to attend a continuing medical education course on addiction. She notes that all doctors have been mandated since 2001 to complete a course in pain treatment.

She also recommends that doctors be required to check their state’s prescription drug monitoring programs before writing prescriptions for opioids and other controlled substances. Some states have already made this a requirement. Doctors must be made aware of new billing codes that allow them to be reimbursed for addiction counseling, Lembke states.

She warned the “problem of doctors prescribing addictive analgesics to patients with known or suspected addiction will be solved only when the threat of public and legal censure for not treating addiction is equal to that for not treating pain, and when treating addiction is financially compensated on a par with care for other illnesses.”

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