Follow Precautions When Prescribing Opioids
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J. JERRY RODOS
To the Editor:
Important issues were raised in the letter by Dr Todd Fredricks in the November 2005 issue of JAOA—The Journal of the American Osteopathic Association (“Doctors' dilemma: prescription pain medications.” 2005;105: 493–495). The anecdotal experience described by Dr Fredricks concerning the abuse of opioids by patients with no medical need for these pain medications highlights the valid concerns of many physicians. To confront these concerns, I urge physicians to review the list, compiled by Cole,1 of common practices that get physicians in trouble when prescribing opioids. These practices include the following.
Failure to evaluate the patient, such as not obtaining a personal history or conducting a physical examination of the patient.
Failure to make any diagnosis prior to starting treatment with a controlled substance.
Failure to obtain outside medical records of the patient, to talk with practitioners who previously treated the patient, or to obtain any verification at all of the patient's condition.
Failure to establish goals for treatment (eg, reduction in pain, improvement in function).
Failure to suspect patient misbehavior or substance abuse (eg, no screening for addictive potential, no monitoring through treatment).
Failure to document the diagnosis, treatment plan, and goals for treatment, as well as the patient's continuing need for medication and test results.
Failure to understand what information drug testing can and cannot reveal about patients.
Deviation from the physician-patient “contract” (eg, patient misbehavior is never addressed properly by the physician).
Blind acceptance by the physician of everything said by the patient regarding his or her condition.
Being aware of these pitfalls and following simple precautions to steer clear of the dangers can help physicians avoid the unfortunate experiences that Dr Fredricks outlines in his letter, in which a patient went from physician to physician falsely claiming to have posttraumatic stress disorder so that he could obtain pain medication. Many practitioners have learned the hard way that strictly following such precautions is crucial for the protection of their patients—as well as for the protection of themselves.
1 Cole BE. Prescribing opioids, relieving patient suffering and staying out of personal trouble with regulators. Reprising old ideas and offering new suggestions. Pain Pract. 2002;12(3):5–8. Available at: http://www.aapainmanage.org/literature/PainPrac/V12N3_Cole_PrescribingOpioids.pdf. Accessed February 22, 2006.Search in Google Scholar
The American Osteopathic Association
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- Medical and Legal Issues Related to Brachial Plexus Injuries in Neonates
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- Let the Beauty of the Marketplace Benefit Healthcare
- Response
- Residents' Wisdom Regarding Narcotics
- Follow Precautions When Prescribing Opioids
- CME QUIZ ANSWERS AND DISCUSSION
- Answers to January 2006 JAOA CME Quiz
Articles in the same Issue
- LETTERS
- Still's Concept of Connective Tissue: Lost in “Translation”?
- Whole Person Medicine: A Definition Articulated Osteopathically
- Continuity of Thought and Tradition in the Discipline Supported by Ongoing AOA Efforts
- Response
- EDITORIALS
- Women's Reproductive Health and Neonatal Care
- AOA COMMUNICATIONS
- With Second Essay Competition, History Committee Offers More Incentives to Explore Profession`s Past
- BOOK REVIEWS
- One Minute Asthma: What You Need to Know
- ORIGINAL CONTRIBUTIONS
- Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature
- Postpartum Outcomes in Supine Delivery by Physicians vs Nonsupine Delivery by Midwives
- REVIEW ARTICLES
- Breastfeeding, the Immune Response, and Long-term Health
- SPECIAL COMMUNICATIONS
- Medical and Legal Issues Related to Brachial Plexus Injuries in Neonates
- LETTERS
- Let the Beauty of the Marketplace Benefit Healthcare
- Response
- Residents' Wisdom Regarding Narcotics
- Follow Precautions When Prescribing Opioids
- CME QUIZ ANSWERS AND DISCUSSION
- Answers to January 2006 JAOA CME Quiz
