Dialogue Volume 12 Issue 3 2016 - Page 11

Blanket “no narcotics” policy not an option Some physicians – concerned about feeling obligated or pressured to prescribe narcotics to patients who ask for them – feel that it is easier to simply have in place a general ‘no narcotics’ policy. But the College says that such a move is not part of the practice of good medicine. “Having a blanket ‘no narcotics’ policy removes the physician’s ability to exercise his or her clinical discretion when considering whether or not to prescribe narcotics and controlled substances to a particular patient. Instead of having such a policy, it is advised that physicians use their professional judgment to determine whether prescribing narcotics and controlled substances is appropriate for each patient. Physicians have no obligation to prescribe ties, sleep, relationships, enjoyment of life, etc. The higher the number, the worse the function. With that baseline, it’s easier to assess the effectiveness of interventions. Consider a patient who describes his pain as 9 out of 10, and can’t walk up the stairs or play with his children. “If I give medication, and you say your pain is still a 9 but you’re walking 2 km a day and enjoying life more, that’s a huge victory,” says Dr. Murphy. ““There are simple tools to measure function. And we continue to monitor that throughout their care.” Dr. Murphy gets many consults for people on highdose opioids. If they score high on functional interference and are on high-dose opioids, the narcotics just aren’t working. So that opens a discussion on strategies. The functional score isn’t perfect, says Dr. Murphy, “but it gives us an indication if we’re winning or losing.” It would be ideal if opioids are given only to people who have functional improvement and no risk. The reality is that opioids are a tool, he says, and any tool can be a problem if you don’t use it at the right any drug, including narcotics and