In the US, pain is the number one symptom that drives people to see their doctors. Given that fact, it's not surprising that's what many physicians try to cure their patients of.

But according to psychiatrist Dr. Michael Clark, Director of the Adolf Meyer Chronic Pain Treatment Programme at Johns Hopkins Hospital, the doctors really need to look at their patients more closely.

He sees hundreds of patients every year and typically they've been suffering for years and feel they've exhausted all other avenues.

In an interview with Body and Soul, he said he's often surprised at the amount of painkillers doctors prescribe to a single patient.

As part of the Continuing Medical Education Programme of the Bermuda Hospitals Board, Dr. Clark spoke to local doctors on the role they play in ensuring their patients do not become addicted to their meds.

In our interview Dr. Clark said prescribing patterns in the US show primary care physicians, (GPs) typically give their patients low doses of opiods (drugs in the morphine family that are addictive) like between ten and 15 milligrams a day to help them manage pain. "This amount is fine," he said.

Outpatient clinics specialising in pain management tend to double that amount while University-based programmes tend to give about 60 milligrams and more intensive outpatient clinics – about 120 milligrams.

But he said of great concern are the patients that come to the clinic who have been taking between 600 and 1,500 milligrams of morphine or its equivalent, every day.

"We routinely see patients on that quantity of opiod," he said. Those are patients who are obviously not doing well. That they have been given larger and larger amounts of opiods despite the fact that they are not doing well is a real cause for concern," he added. "Why would someone keep prescribing something that is obviously of no benefit?"

Concern over the trend has reached the state medical licensing boards in the US with doctors and administrators trying to stamp out the problem.

"They are trying to figure out what are those doctors doing," said Dr. Clark. "Are they just stupid and don't know what they are doing and don't have the capacity to do anything else, or are they contributing to drug abuse and drug diversion by providing larger and larger quantities and saying pay me under the table or you pay me per prescription – I can make a lot of money."

In fact the concern is so great that according to Dr. Clark, there's a real effort to have a nationwide database for prescription medications. Many US states already have such databases.

"If someone comes in and you want to see what kind of opiods they've been prescribed you can type their name and birth date and up will come every prescription they've used, every pharmacy and every doctor that prescribed for them," he said.

In Bermuda local pharmacies will contact the Pharmacy Inspector in the Ministry of Health in situations that concern them. Where there is a suspicion of abuse, the individual is restricted to one pharmacy to have prescriptions filled. All pharmacies on the Island honour this arrangement, which enables swift and close monitoring of both the patient and the prescribing physician.

In his talk, Dr. Clark urged local physicians to set guidelines for themselves in arriving at their decisions to prescribe addictive painkillers. He also recommended physicians have a plan for how and when they will take their patients off such medications.

He suggested the use of long acting painkillers for those who will need the drugs for extended periods of time. Dr. Clark also pointed out that pharmaceutical companies are developing abuse-resistant and abuse-deterrent pills that will help prevent overuse of painkillers.