One-Size-Fits-All Limits on Opioids Are Ethically Problematic
Elected officials and other health agencies and advocacy groups are enacting many new requirements to combat the opioid epidemic.
“We can all agree that decreasing the use of opioids is the right thing to do for patients,” says Joseph Bosco, MD, professor in the department of orthopedic surgery at NYU Langone Health.
Physicians are morally obligated to lead the way in opioid reduction, Bosco adds. He and other research colleagues recently reviewed various interventions with an ethical lens.1
“The current opioid crisis generated immediate actions at many levels,” says Claudette Lajam, MD, the study’s lead author and an associate professor at NYU Langone Health, also in the department of orthopedic surgery. Regulatory requirements were implemented quickly. These placed seemingly arbitrary limits on prescribing, even for painful surgical procedures. “We wanted to examine the ethical implications of regulatory changes and physician-led changes,” Lajam says.
According to the analysis, these regulatory interventions are ethically sound:
- requirements for educational programs for prescribers and patients;
- robust prescription monitoring programs that cross state lines;
- more prescriptions of naloxone for at-risk patients;
- development of condition-specific pain management guidelines;
- improvement of opioid disposal programs;
- elimination of pain control questions from patient satisfaction surveys.
“Arbitrary, one-size-fits-all limits on opioid prescribing were less ethically sound due to interfering with autonomy and nonmaleficence,” Lajam says.
- Lajam CM, Cenname J, Hutzler LH, Bosco JA 3rd. Ethics of opioid prescriber regulations: Physicians, patients, and pain. J Bone Joint Surg Am 2019; Oct 9. doi: 10.2106/JBJS.19.00437. [Epub ahead of print].
The current opioid crisis generated immediate actions at many levels; regulatory requirements were implemented quickly. However, some of these placed seemingly arbitrary limits on prescribing, even for painful surgical procedures.
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