Prescribing Opioids Responsibly in Emergency Situations

Controversies around the use of opioids for chronic pain relief

There have been many controversies around the use of opioids for chronic pain relief. Though they are considered as reliable analgesic agents, opioids have also been considered liable for abuse and addiction. This paper disagrees with a majority of the sentiments that suppose that there is a need to withhold the prescription of opioids, in an article on prescribing opioids responsibly in emergency situations (Pentin). This paper also agrees on two sentiments from the article, which proposes a deeper examination of patients even in emergency situations, and the questionable effectiveness using opioids to treat chronic pain in the long-term.

Patient's subjective measure of pain and abuse

The article argues that patients have learned that their pain cannot be confirmed or ruled out by tests in an emergency situation, and doctors have to rely on their subjective measure of pain to prescribe opiates, and even those with valid pain may exaggerate it. This, it says, has resulted in abuse and addiction. It blames the abuse on the prescriptions made by doctors. However, the current opioid epidemic cannot exactly be attributed to the prescription of these pain-killers by doctors. Though abuse of prescribed opiates does happen, results by SAMHSA suggest that only less than 20% of abusers got the drugs directly from a doctor's prescription, while a whopping approximately 70% got them illicitly (Fields). Furthermore, the fact that some patients have abused these drugs does not eliminate the fact that many patients also come to the doctor with valid pain that requires treatment (Fields).

Low addiction risk and abuse of opioids

The article seems to suggest that the use of opioids has led to addiction. However, the evidence provides that opioid use for pain relief in patients who have not been on opioids before is associated with very low addiction risk, with only 2% developing opioid abuse. A 6% rate of abuse was observed on those treated with opioids who had previously used illicit drugs (Fields). The abuse of opioids cannot be equated with an addiction of the same, and this needs to be addressed more from a social, cultural or legal point of view as opposed to a medical one. It is important, therefore, for the medical field to find a way of distinguishing opiate addicts from pain patients since these two are clearly separate populations.

The role of doctors in opioid prescription

The article claims that doctors have created the suffering that has arisen from the prescription of opioids. The argument is that doctors have made prescriptions which patients have abused, and in turn have found themselves in the emergency room seeking more of the opiates or with respiratory depressions. This may be true in some way since it is difficult for doctors to tell a genuine case from that of one faking pain to get a prescription. However, the doctor, if not inspired by genuine care for their patient’s well-being, may only be making an attempt to provide pain relief as a way of meeting the required standard of care, or even a law in some states. Besides, a person who lies to get a drug prescription is already a drug abuser, so the doctor is not necessarily creating a new addict (Fields).

The effectiveness and long-term use of opioids for chronic pain treatment

In support of the article, the effectiveness using opioids for chronic pain treatment may not be effective in the long run. The article indicates that patients to whom opioids are prescribed, such as in the case given of a sickle-cell patient, addiction and dependence on these opioids are likely to happen. While opioids are effective in relieving pain when used acutely in patients with chronic pain, there may be adverse effects of committing patients to the use of opioids in the long run. Studies suggest that dependence is likely, and the worsening of pain is likely to result. In addition, tolerance to their effects is likely to happen. These may be among the reasons for abuse by overdosing or illicitly accessing the drugs to retain analgesia. Though these may not be the intended or desired results when practitioners prescribe opioids, the long-term effects are inevitable.

Prescribing opiates responsibly

The article suggests that the prescribing of opiates needs to be done by looking beyond the surface – beyond the pain, the patient seems to be in at that moment. Patients need to be partners in their own care, by allowing themselves to go through a physical examination, urine and blood tests, so that underlying physiological issues can be determined. For this to be done effectively in emergency situations, the article suggests the use of electronic media to keep a record of and share information on patients, so as to ensure the safety of prescribing opiates. Though the extent of steps to make this possible are quite on a large scale and would involve looking into government requirements such as confidentiality, I agree with the sentiment. It is important for practitioners to consider the continued well-being of patients by taking any measures possible to gain necessary information that will guide the prescription of opiates for long-term treatment of chronic pain (Fields).

References

Fields, Howard L. “The Doctor's Dilemma: opiate analgesics and chronic pain.” US National Institute of Health (2012).

Pentin, Pamela L. “Drug Seeking or Pain Crisis? Responsible Prescribing of Opioids in the Emergency Department.” American Journal of Ethics (2013).