The narcotic epidemic has affected all of us. For me, I have a few patients who I’ve felt comfortable managing their pain. These patients also have significant medical problems. As our clinic goes to a standard of not prescribing narcotics, I worry that i may lose the close follow up I have with these particular patients. I agree that sending to pain clinic, weaning off narcotics, or switching to long acting opiates is the best next step. But opiate addiction is a strong deterrent to seeking care for what is most important (managing HF, COPD, etc). I worry that these patients will leave the clinic to seek other providers, taking a step back on the progress we have made. But this is the reality. This is the problem. Narcotic addiction takes precedent over everything else. This is one of many examples that we can discuss in the role narcotics play in the social determinate of health.
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