Prescribing opioids amid the overdose crisis

Hidden so they don't bias your answer. Score yourself first, then reveal them to compare.

• Resist the two easy extremes: reflexively refilling, or abruptly abandoning the patient. Abrupt discontinuation or 'firing' patients on chronic opioids is itself dangerous and is now explicitly cautioned against, because it can drive people to illicit fentanyl and precipitate withdrawal or overdose. So your stance should be calm, non-accusatory inquiry. Tell the patient honestly what the PDMP shows, ask open questions about how he is using the medication and whether his pain or life circumstances have changed, and treat the discrepancy as information to understand rather than a crime to prosecute. Interviewers want to see clinical curiosity and a therapeutic alliance preserved under pressure.
• Show you understand the crisis as a system, not a morality tale. A credible answer sketches the arc: aggressive prescribing in the 1990s and 2000s amid pain-as-fifth-vital-sign campaigns and misleading marketing, followed by a tightening of supply, then waves of heroin and now illicitly manufactured fentanyl driving the majority of overdose deaths. The lesson is that simply cutting prescriptions without offering treatment can push patients toward a far more lethal illicit supply. The CDC's revised 2022 guideline deliberately moved away from rigid dose ceilings toward individualized, patient-centered care, and citing that signals genuine currency.
• Pivot to what you would offer if use disorder is in play. Strong candidates name screening, a respectful conversation, naloxone co-prescribing, and access to medications for opioid use disorder, buprenorphine or methadone, which are evidence-based and lifesaving, plus the fact that the federal X-waiver requirement to prescribe buprenorphine was eliminated, broadening access. The throughline is harm reduction and continuity: you do not solve this by severing the relationship. Demonstrating that you can hold compassion and appropriate caution simultaneously, while keeping the patient engaged and safe, is exactly the maturity these stations test.