Opioid Counterpoint

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Opioid Counterpoint

I read Dr. Ilahi’s recent Touch with interest and admiration and I applaud his efforts to reduce his patients’ need for strong opioids. With the recent attention focused on opioid abuse in America, reports like Dr. Ilahi’s are becoming more common, and there is a push for doctors to standardize their prescribing in order to reduce opioid usage. However, as an Orthopaedic Oncologist, I have some patients that require strong opioids. Do they require them because I have over-prescribed? No, they require them because they have a condition that results in severe pain. Should I try less potent drugs initially? Absolutely. But, I should also tailor a medical regimen on an individual, per patient basis.

Let us beware of the pendulum swinging back too far. Attempting to standardize pain assessments and treating patients solely based on a pain score has contributed to the current opioid issue. Many doctors yielded to this approach due to Joint Commission pressure and fears of low HCAHPS scores. Let’s not fall into the same trap due to fears of being singled out for “over” prescribing. An individualized approach is required. Like Dr. Ilahi, talk with your patient, make a personalized decision based on that discussion, and use the least amount of opioid possible for the shortest period of time, but do so without withholding in those circumstances when something stronger is required.

Bryan Moon, MD
[email protected]

(Courtesy of Robert R. Slater Jr., MD)

DISCLAIMER: Statements of fact and opinion are the responsibility of the authors alone and do not imply an opinion or endorsement on the part of the officers or the members of WOA unless such opinion or endorsement is specifically stated. Materials may be reproduced only if Touches and the Western Orthopaedic Association are credited.


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