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Physicians bear responsibility for careful and conscientious prescribing, which includes patient assessment, communication, and education. 22 Therefore, prescribing and patient education practices play a role in the availability of opioids for misuse 23 and the harms that flow from OUDs. 21 Additionally, about 27% of long-standing opioid abusers receive these drugs directly by prescription. 20 Except for the opioids diverted in the supply chain before reaching dispensers, borrowed or stolen opioids originate as valid prescriptions. 19 Although most of those with OUDs and those who suffer opioid related overdoses (OROs) do not obtain their opioids directly from their physician, some do. 18 Because opioids are regulated, prescription-only medications, dispensers, distributors, and physicians are all facing scrutiny. 17 OUDs also carry societal and economic costs. 16 In addition, the majority of individuals with OUDs do not receive treatment, despite the significant psychiatric co-morbidities and risk of overdose death.
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15 Opioid use disorders (“OUDs”), a subset of SUDs, are now the “second most common drug use disorder” in the United States, and prevalence has increased over the last two decades. Although any inappropriate prescription can have negative consequences for both physicians and their patients, those consequences are significant in the case of opioids. In limited instances, physicians may behave negligently or worse in prescribing opioids. 13 These deaths have garnered significant public attention. 12 In 2010 alone, an estimated 16,000 individuals died from nonmedical use of prescription opioids, typically in combination with other drugs or alcohol. 10 A small percentage of patients with underlying vulnerabilities to substance use disorders (“SUDs”) may develop opioid use disorders from prescriptions to treat pain, while other individuals with SUDs 11 find a new drug of choice in diverted prescription opioids. Though many patients experience a newfound relief from suffering, 9 the nonmedical use of opioids has also increased substantially. On the other hand, medicine’s embrace of expanded opioid use and the influence by pharmaceutical companies on that use 8 has had unintended consequences. 5 According to Cheatle and Savage, “ne of the barriers to effective pain management across the spectrum of pain conditions … is the clinician’s fear of prescribing opioids beyond that merited by the actual risks.” 6 Efforts in 1990s to lessen barriers to appropriate opioid use did result in decreased suffering for some patients. 4 Although opioid prescriptions are only one aspect of effective pain treatment, the failure to utilize opioids in appropriate circumstances causes suffering and creates a barrier to effective pain care. 2 The inadequate treatment of pain was the subject of significant clinical and policy efforts in the 1990s 3 among those efforts were the increased use of opioids for acute pain and the use of long-term opioid therapy for patients with chronic pain. On the one hand, relief from suffering is a primary obligation of physicians, and pain remains undertreated after decades of improvement efforts. Physicians are understandably conflicted about how, when, and whether to prescribe opioids. They are widely feared compounds, which are associated with abuse, addiction and the dire consequences of diversion they are also essential medications, the most effective drugs for the relief of pain and suffering.” 1