Dialogue Volume 13 Issue 3 2017 - Page 39

PRACTICE PARTNER Opioids can be an effective tool, but discussing them requires context and inquiry. portant. So is what he calls being tactful but blunt. Tell the patient that your job as a doc- tor is to help them manage their pain, and also explain how opioids can cause harm and that harm can be a side effect. Or sometimes the harm can masquerade as benefit, i.e., the perception that the drugs are helping when they’re just hampering withdrawal – “Where the main reason to be on a drug is because you’ve been on it,” Dr. Juurlink says. Acknowledge the fear of tapering With patients who are already on high-dose opioids (whether existing patients or those you fRW&FVBFRFW&r6fW'6Fআ2G2v6VvW2FVG2fRVFW'7FF&RfV'2FPfV"b6vRfV"bvFG&vfV"`"fV"FBvW"F6W2"@FW&FfW2v( Bv&( FW&^( 2gFV&VfW&V6RFVWFw0FRvFW&R"RV"( ( VvFЦFRFVBBFF7BF2w0RFvWBWBb&VBFR&r( PVVBFv6vǒ( 62G"WW&Ɩvr6rƖW2F&FFRF67W76BFR7G&FVwf'7BFRFRFSFW6RFVG2VVBCP֖WFW2BR֖WFW2F7F'26VB6&V77W&RFVFB6֖rfbG2v( @VfW&vBw&Fr&W67&FFV6ǒ6&R֗7FR66vVpFVG2FV6ǒFR&vBW76vW267W'B7V66W72rF֗BFB&֖vB&RFff7V@f"&FFRF7F"BFRFVBFWfVFRFƲ&WBFR76&RVffV7G0&VFVBF&vVBBv@W6RFRW&6WFbvN( 2&( 0&VB66BVFgV2ЧFBFW"76&R7G2( 26&V6R6WvVBfW"FRFVG2BgVǒ&V6v旦RFR&&V2"FV 6W&6W2r( BVFvRFRFVBvF6VG0@&WBFV"7F2RrvrF&Vv2FV6ǒ7FVB66VG&FRFRFVF&26&gFR&FR&VB&V6VBЦrFW"RFR6Ɩ6WfFV6R@FR6vW26Ɩ6F涖rr6vVFvRFRFVN( 2fV'2'W@WrƖfR6VB&fRvFFP&vBFW"&Vf&6RFBFRFW"v&RFfGRЦƗVBBw&GV&RWfVV "&RFvfRFR&GFRFFW7BखbVVFVBFRFW"6&RW6VBrFBVFFVǒF22&W@PvWGFrF6RvW&RFR&6&Wv&@&6RFG27G&vǒffW"bFP&VVfG2( FR'W֖2fW''FB( G"WW"ЦƖ62( FW6R&RVRvB&PFF7FVB'WBv6RƗfW2&WffR&VBVG2VRvFW"6vǒW7V6ǐg&vF6W2fR6VvW2ЧFǒ'WBFVBWfVVƖr&WGFW"FWvvW"fVVFBFW&R&6VB( Ф@55TR2#rDuTP3