Nearly 2 million Americans have an opioid use disorder. While there are many causative factors behind that staggering number, Steven J. Stack, MD, president of the American Medical Association, says “the opioid epidemic…far too often has started from a prescription pad.” In an open letter to all physicians in every setting across the country, Stack proposed seven steps physicians can take to help reverse the tide:
- “Avoid initiating opioids for new patients with chronic noncancer pain unless the expected benefits are anticipated to outweigh the risks. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred.
- Limit the amount of opioids prescribed for postoperative care and acutely injured patients. Physicians should prescribe the lowest effective dose for the shortest possible duration for pain severe enough to require opioids…. Professional judgment and discretion is important in this determination.
- Register for and use your state Prescription Drug Monitoring Program to assist in the care of patients when considering the use of any controlled substances.
- Reduce stigma to enable effective and compassionate care.
- Work compassionately to reduce opioid exposure in patients who are already on chronic opioid therapy when risks exceed benefits.
- Identify and assist patients with opioid use disorder in obtaining evidence-based treatment.
- Co-prescribe naloxone to patients who are at risk for overdose.”