Opioid Addiction Epidemic: What Has To Be Done?

There are both scientific and ethical factors that must be taken into consideration in order to develop effective medical and behavioral treatment options for patients with chronic pains and cancers when prescribing opioids, all while avoiding the possible effects that this prescription can have on its dependence. Opioid dependence and use disorder has increased into a worldwide epidemic that has increased nearly 500% since 2010, but these pharmaceuticals are some patients only hope in living pain free creating many ethical issues involved when prescribing such medications. In autonomy, the patient’s right to self-determination is in question as both long and short term effects to opioid use can lead to intoxication and withdrawal. This then doesn’t allow these patients' consent to be deemed valid as the consent must be given from one that is competent in making decisions for themselves, one who has been provided key information, and has chosen to participate voluntarily. However, are these patients really incompetent to make decisions for themselves? This is the issue that relates to justice, treating all patients equally. This leads into the two biggest ethical issues involved in opioid use and the disorder, is that of beneficence and nonmaleficence, that is the duty to do good and not to do bad by these treatments. When prescribing these medications as a medical professional, these are all factors that must be taken into consideration. Is this patient’s pain unresponsive to other treatments? Is prescribing this medication to relieve the pain benefit worth the risk of potential withdrawal? Unfortunately, this question doesn’t have a direct answer and therefore is deemed as the leading cause to the opioid epidemic in the world today. There are people with chronic pain that are unresponsive to other pain control treatments and need these medications to improve their quality of life, while there are others who don’t need to be prescribed opioids but are. 

So, how can we determine when opioid prescriptions should be prescribed to patients and when they should not? The answer is still unclear. There are some regulations, however, that have been implemented such as monitoring programs, pain management guidelines, prescription limits, and educational programs for both users and prescribers in order to control the overprescribing and usage of these medications. These regulations are still being changed, like limitations and pain management guidelines, in order to decrease opioid use as it has been shown that not enough of these prescriptions can have negative effects and therefore increase opioid use as well. Though these regulations aren’t perfected yet, they provide a hopeful future in limiting opioid use disorder and the ethical issues that follow. 

Lajam, Claudette M. MD; Cenname, John BBA; Hutzler, Lorraine H. MPA; Bosco, Joseph A. III MD. Ethics of Opioid Prescriber Regulations: Physicians, Patients, and Pain. The Journal of Bone and Joint Surgery 101(23):p e128, December 4, 2019. | DOI: 10.2106/JBJS.19.00437