Opioids are indicated for many conditions. They can be used judiciously and prudently to improve a patient’s state of being and comfort. There may come a time, however, when the risks exceed the benefits of a medication; it doesn’t matter if the medication is a controlled substance or not. The issue then becomes one of ceasing its use.
Patients with chronic pain are often affiliated with pain-management physicians who specialize in the treatment of chronic pain. With their guidance, patients can navigate the waters of analgesic pharmacotherapeutics with direction and confidence. The relief of acute pain is what opioids are for. It’s the time factor that muddies the water.
Beyond the time a medical condition has run its course, the use of opioids becomes inappropriate. I don’t deny that some conditions never do run their course and severe pain becomes a part of a patient’s daily existence. The point is, there is no black and white when it comes to pain management.
Under ever-increasing scrutiny and media attention, providers are being pressured to veer away from writing prescriptions for opiates. When a patient is suddenly cut off from the usual source of their pain meds, they may resort to frequenting emergency departments for refills. I don’t think this is done out of contrivance all the time, but rather necessity. ER physicians do not routinely refill prescriptions for narcotics but are be pressured with increasing frequency to do so.
It can get to the point where violence is foisted upon the provider. I myself have had a gun pulled on me by a drug-seeking patient. I don’t judge the patients who feel they need these medications, but I can’t responsibly enable the continuation of the patient’s problem.
We physicians are bound by oaths and statutes to do no harm. The overall context of short and long-term treatment and what is best for the patient has to be considered. When that does not correlate with the perceived needs of the patient, there will be conflict.
For resolution of the opioid crisis, we must come to consensus on defining the problem before we can efficaciously address the issues. Moreover, the perspectives of lawmakers do not match those of the population segments for which the legislation is intended.
Richard E. Draper, a double board-certified emergency medicine physician, blogger, and speaker, and practices in the Kaleidoscope Weekly distribution area. The Healer’s Heart is based on his perceptions and observations of his experiences in the ER over his career. Any similarities to actual patients are purely coincidental.