Suddenly empowered to write prescriptions as a new resident, Jonathan Chen, MD, PhD, knew the basics and had more senior physicians to ask for advice when needed. But when he encountered patients asking repeatedly for opioids, he was given confusing, conflicting and sometimes insensitive guidance.
Chen, a Stanford instructor of medicine, recounts his experiences learning to treat addicted patients in a thought-provoking essay (subscription required) recently published in JAMA. He writes:
I soon found that the patients I least wanted to see were those fixated on negotiating for additional opioids in the hospital. These were the cases where I was caught between challenging patients and inconsistent supervising physicians, between the power to prescribe potent medications and learning to compassionately manage pain, and between social mores steeped in prioritizing pain treatment to one recognizing the dangers of the misuse of prescription opioid drugs.
What can be done? For one, Chen says, addiction, just like heart disease, diabetes, or any other ailment, needs to be recognized and treated as a real medical problem. And, he writes:
When I work with medical trainees, I hope that we can together learn a thoughtful and consistent approach to opioid prescribing in both acute inpatient and chronic outpatient settings... While many clinical topics compete for education priority, prescription drug misuse and addiction is one that an inadequately trained medical community will routinely contribute to, if not overtly cause.
Previously: New money for opioid abuse welcomed to help uninsured, says Stanford's Keith Humphreys, Opioid abuse among seniors: Stanford pain expert testifies on issue before U.S. Senate and Stanford addiction expert: "The country needs to spring into action" on heroin epidemic
Photo by Daniel Foster