We doctors seek tricky balance on opioids

The problems of opioid abuse – both prescription and illegal drugs – are well documented. But the solutions are not always simple, particularly when balancing the need to manage a patient’s pain with the addictive qualities of certain medications and the potential for abuse or even diversion.

When prescribed and monitored appropriately, opioids offer much-needed relief. For years, physicians were emphatically urged to control their patients’ pain, measuring pain as “the fifth vital sign.” As a result, physicians tried to provide appropriate relief to mitigate their patients’ suffering.

There’s no doubt that effective pain management is critical to preserving one’s quality of life. As family physicians, we generally prescribe opioids as a last resort, because we are strongly aware of the possible outcomes. Family physicians typically begin pain management with a treatment plan that includes non-opioid solutions such as physical or occupational therapy, oral anti-inflammatory medications, acetaminophen and antidepressants. But health plans may not always cover every treatment for pain.

Medicines have changed our lives for the better. We have eliminated diseases; we have found ways to cure what was once deadly, and treat that which cannot be cured. But medicines need to be thoughtfully prescribed and monitored. Our professional associations continually provide us with education about appropriate pain management, alternatives to opioids and how to recognize signs of abuse. But there are not always quick answers or one-size-fits-all approaches.

We do know that honest dialogues between patients and their primary care physicians are critical. We count on our patients to be honest partners with us in developing individualized healthcare solutions.

If you or your loved one is struggling with opioids, help is available. Call your doctor. We care about your health. Together, we will help you find the best path forward.

Dr. Brown is president of the N.C. Academy of Family Physicians.