Drug Soup and Doctoritis

The current opioid crisis requires pain specialists to use caution and navigate carefully when prescribing pain medications.   Along with opioids we are often faced with another medication problem that we are seeing more frequently.     I’ve taken to calling this drug soup.   Medications that work in the central nervous system (CNS) and alter brain chemistry are being prescribed for every imaginable symptom.     Since patients frequently see more than one doctor, they often get different centrally acting drugs from different prescribing physicians.  We are often consulted to be in this group of specialists.   In a situation with multiple prescribing physicians I often use the term “too many cooks in the Kitchen” or “doctoritis”.   I am uncomfortable being part of doctoritis but many times we’re in the mix.

There are some patients that expect a pill for every one of life’s problems.   Pain, depression, stress, anxiety, insomnia, lethargy, lack of energy, lack of concentration and grief are all common complaints that physicians hear about daily. There are pills to address all of these symptoms and believe me, some patients have them all!   In addition to opioids, there are antidepressants, muscle relaxants, nerve pain medications like gabapentin and non-narcotic pain meds.   In addition there are stimulants for ADHD and there are sedatives and sleeping pills to shut people down.   It is not unusual for us to see a new patient to show up in our office with 7 or more “centrally acting drugs” on their daily list. DRUG SOUP! This doesn’t include the medications taken for heart disease, diabetes, asthma and other medical conditions.

We are a pill popping culture.   This drug soup occurs gradually over time but if you try to simplify these regimens, you‘re often messing with medications prescribed by another physician. It can be a delicate situation to change someone else’s treatment plan.

Patients on this many drugs are often not doing well, that is why they show up in a specialty pain clinic. It is no surprise that the drug interactions are unpredictable and dangerous.  Despite discussing this at length I also often find reluctance from patients on drug soup to simplify their regimen.   The reasoning and logic is generally along these lines, “if I don’t feel good taking all these drugs to make me feel better, then I’ll surely feel worse if I stop one.”   That thought is deeply ingrained.     Reducing central acting medication loads is a slow process of tapering and requires full patient buy-in or else it’s doomed to failure. Alternatives to pills need to be part of the conversation.

America loves to find a villain for every problem.   Right now, opioids are taking all the heat for drug overdose and addiction. That’s a real problem and it must be addressed, but in my opinion, DRUG SOUP and the desire to take a pill for every one of life’s challenges is another huge problem that needs our attention.