Prescribing opioids amid the overdose crisis
MMIHardAnswer the question
Prescribing opioids amid the overdose crisis
A long-term patient on chronic opioids for genuine pain asks for an early refill, saying he ran out. The state prescription drug monitoring program shows he recently filled a similar prescription from another provider. Against the backdrop of the US overdose epidemic, how do you handle this consultation?
How do you balance the duty to treat pain against the risk of contributing to misuse or diversion?
What is your understanding of how the opioid crisis evolved, and how should that history shape prescribing today?
If you suspected opioid use disorder, what would you offer rather than simply cutting him off?
Speak it out loud and we'll type it for you (free), or type your own notes — then mark yourself below.
- Four pillars: autonomy, beneficence, non-maleficence, justice.
- Name the conflict → weigh both sides → gather more info → safe, patient-centered action.
What strong answers doReveal the benchmark
Hidden so they don't bias your answer. Score yourself first, then reveal them to compare.
- Resist the two easy extremes: abrupt discontinuation or 'firing' the patient is itself dangerous and can drive people to illicit fentanyl, so lead with calm, non-accusatory inquiry about what the PDMP shows and how he is actually using the medication.
- Understand the crisis as a system: aggressive promotion of long-acting opioids, pain treated as a vital sign, then a supply squeeze that pushed people to heroin and illicit fentanyl; the CDC's 2022 guideline moved from rigid dose ceilings to individualized care.
- If you suspect opioid use disorder, name it as treatable and offer buprenorphine or methadone, naloxone for the household, and a warm referral rather than a phone number.
Mark yourself
Score each skill against the rubric, then add a line of evidence. Scale:
Ethical reasoning
0/3Balances the duty to treat pain against diversion risk without abandoning the patient
Empathy
0/3Approaches a difficult disclosure with curiosity rather than accusation
Knowledge of the healthcare system
0/3Understands the crisis's history, PDMPs, the 2022 CDC guideline, and MOUD access
Decision-making under uncertainty
0/3Acts safely without complete information