Follow Precautions When Prescribing Opioids
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《美国整骨期刊》
Midwestern University/Chicago College of Osteopathic Medicine Downers Grove, Ill, Adjunct Professor of Social Medicine Ohio University College of Osteopathic Medicine Athens, Ohio
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.
References
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.(J. JERRY RODOS, DO, DSc, )
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.
References
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.(J. JERRY RODOS, DO, DSc, )