Prescribing Opioids Effectively

Earlier in my career, while at Montefiore Medical Center in the Bronx, I had an experience I will always remember. A husband called in desperation, begging for pain relief for his wife who had end-stage metastatic breast cancer. The oncologist refused to prescribe a heavier dose of pain medication fearing the patient would get addicted. Today, we wonder why this type of unnecessary suffering went unalleviated.

At the same time, other physicians were examining how best to treat pain. It was argued that people suffering from chronic pain could safely take opioids for months or years. Among the assertions physicians made in the 1990s were:

• Less than 1 percent of opioid users became addicted.
• The drugs were easy to discontinue.
• Overdoses were extremely rare in pain patients.

In retrospect, after many thousands of unnecessary opioid-related deaths and hardships, this prescribing philosophy was unsuccessful.

Virtually no one wants to return to a time when doctors were reluctant to use opioids, even for end-stage cancer patients. However, there is widespread agreement that opioids can be used, with caution, for acute pain post-surgery.

Now that our understanding has evolved, it is important for all physicians to think about how they can personally contribute to helping overcome our nation‘s opioid epidemic—by treating pain conservatively and appropriately, and by doing what‘s right, in the big picture, for the patient.