Reconciling Patient Safety and Epistemic Humility: <i>An Ethical Use of Opioid Treatment Plans</i>

Ho, Anita

doi:10.1002/hast.703

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…The physician may also request pill counts of opioid medication to verify that they are being taken as prescribed and ask to review opioid treatment agreements (OTAs), which define the parameters of opioid use 40–42. Each of these measures may erode the relationship between the patient and physician, and some scholars debate whether any of these measures should be even allowed 43. For instance, OTAs can lead to stigmatisation with little evidence that they are effective 44 45…”

Section: Discussionmentioning

confidence: 99%

‘I just need an opiate refill to get me through the weekend’

Yan¹,

Kuo

2019

J Med Ethics

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In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the easy availability of prescription opioids. More recently, this problem has been seen outside of North America affecting individuals at similar rates in Australia and Europe. We argue that physicians are also confronted with an ethical crisis where a capitalist-consumerist society is contributing to this opioid crisis in which societal, legal and business interests push physicians to overprescribe opioids. Individual physicians often find themselves unequipped and unsupported in attempts to curb the prescribing of opioid medications and balance competing goals of alleviating pain against the judicious use of pain medications. Physicians, individually and as a community, must reclaim the ethical mantle of our profession, through a more nuanced understanding of autonomy and beneficence. Furthermore, physicians and the medical community at large have a fiduciary duty to patients and society to play a more active role in curbing the widespread distribution of opioids in our communities.

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Section: Discussionmentioning

confidence: 99%

‘I just need an opiate refill to get me through the weekend’

Yan¹,

Kuo

2019

J Med Ethics

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“…47 For instance, crafting agreements that, like the Pennsylvania sample OTA, require physicians to solicit the goals of care from the patient creates an opportunity for physicians to exhibit epistemic humility, where the decision about whether to start or continue LTOT can be "an iterative and collaborative activity." 48 Finally, holding physicians accountable for how they use their discretionary powers will require better monitoring and data collection regarding the aggregate outcomes of physician behavior. Health systems and clinics need to keep good records of which patients have signed OTAs and how the terms of those agreements are being enforced.…”

Section: Discretion Over Reportingmentioning

confidence: 99%

‘First Do No Harm’: physician discretion, racial disparities and opioid treatment agreements

2021

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The increasing use of opioid treatment agreements (OTAs) has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable.

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“…Avoiding qualitative overprescribing requires time and energy—regular comprehensive patient assessments, frank communication, and a willingness to treat or refer patients for OUD treatment. Adherence to ethical risk mitigation strategies, such as opioid treatment plans, can improve patient care and demonstrate carefulness . Prescribing guidelines and state prescribing laws are intended to address qualitative overprescribing.…”

Section: Policy and Politicsmentioning

confidence: 99%

Defining Misprescribing to Inform Prescription Opioid Policy

Dineen¹

2018

Hastings Center Report

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Prescription opioid policies too often reflect over a century's worth of moralizing about the nature of opioid use disorder, the value of pain, and the meaning of suffering. The social and legal penalties to prescribers run in one direction—avoid overprescribing, however defined, at all costs. The lack of shared definitions is problematic for formulating and evaluating opioid policy. For example, the variant definitions of “misuse,” “abuse,” and “addiction” complicate estimates of morbidity. There are also no widely accepted definitions of misprescribing and overprescribing. I offer here a modest attempt at the categorization of misprescribing: inadvertent overprescribing, corrupt overprescribing, qualitative overprescribing, quantitative overprescribing, multiclass overprescribing, and underprescribing.

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Reconciling Patient Safety and Epistemic Humility: An Ethical Use of Opioid Treatment Plans

Cited by 8 publications

References 14 publications

‘I just need an opiate refill to get me through the weekend’

‘I just need an opiate refill to get me through the weekend’

‘First Do No Harm’: physician discretion, racial disparities and opioid treatment agreements

Defining Misprescribing to Inform Prescription Opioid Policy

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