Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

Excerpt

The public health and social harms resulting from misuse of opioids, particularly substance use disorders related to prescription opioids, have been under intense scrutiny in recent years [9, 53]. Some individuals who receive prescription opioids also use heroin, which has additional risks due to unknown potency and adulteration [7]. Center for Disease Control and Prevention (CDC) statistics indicate that 115 Americans die of an opioid overdose each day [8]. Although the dominant media narrative assigns much of the blame to overprescribing or misprescribing by physicians, the news media less than 20 years ago frequently castigated physicians for failing to provide sufficient pain control and dismissed or ignored the possibility that inappropriate deployment of opioids could lead to addiction [36, 44, 67]. As one article published in American Family Physician in 2000 stated: “Despite recent advances in the understanding of pain management, patients continue to suffer needlessly, primarily because of improper management and inadequate pain medication” [4, 44]. In 2001, a story appeared in the Chicago Tribune reporting that “[a] jury awarded $1.5 million to the family of an 85-year-old man who accused his doctor of not prescribing enough pain medication during his final days” [36]. …