Ethical Issues in Opioid Prescribing for Chronic Pain

Jane C. Ballantyne, MD

Penn Pain Medicine Center
Department of Anesthesiology and Critical Care
Philadelphia, PA

The evolution of medicine has shifted medical decision making from a physician-driven process to a guidance–cooperation model of care, in which patients choose among potential treatment options based on recommendations from healthcare providers. Such a model can be problematic when patients and clinicians do not agree on the appropriate course of therapy. This issue compounded when considering long-term treatment with potentially addictive medications, such as opioids. Most would argue that clinician is often better positioned to assess potential risks and benefits for the patient, and thus is under no obligation to prescribe unless the medication is the most likely approach to achieve mutually defined therapeutic goals. Further ethical issues may arise, however, when the desired treatment strategy produces a significant economic or social burden for society as a whole, particularly in light of increasing rates of opioid abuse and related overdose. Nevertheless, the clinician’s primary duty is to the patient, and therapy should be selected based on the relative risks and benefits of all available treatment options.

References

Ballantyne JC, Fleisher LA. Ethical issues in opioid prescribing for chronic pain. Pain. 2010;148(3):365-367.
Sullivan M. Ethical principles in pain management. Pain Med. 2001;2:106-111.
Beauchamp TL, Faden RR. The right to health and the right to health care. J Med Philos. 1979;4:118-131.

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