Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

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. Some individuals who receive prescription opioids also use heroin, which has additional risks due to unknown potency and adulteration. Center for Disease Control and Prevention (CDC) statistics indicate that 115 Americans die of an opioid overdose each day. 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. 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”. 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”.

Since then, the narrative has changed. Headlines such as “Who Is Responsible for the Pain-Pill Epidemic?” and “Doctors Increasingly Face Charges for Patient Overdoses” have led physicians in many cases to be extremely cautious in prescribing opioids and lawmakers to impose highly specific restrictions on treatment use of opioids. Legal actions seeking to impose liability on opioid manufacturers for their marketing practices have focused on the alleged effects of those marketing efforts on physician prescribing. Yet, nothing can relieve the responsibility of the physician as the party ultimately responsible for the decision to prescribe a controlled substance. That responsibility is grounded in professional obligations to treat patients appropriately and according to accepted standards of care, violation of which can lead to professional discipline, peer review actions, and quality-assurance measures. This article evaluates the effectiveness of recent legislative mandates and restrictions on opioid prescribing and proposes alternative frameworks for combatting and preventing harms caused by the misuse of prescribed opioids.

The full article can be downloaded below.