‘First, Do No Harm’ and the Opioid Crisis  

That title implies that there is a connection between the Hippocratic Oath the current opioid crisis. What is it?

Any chronic illness can be used as an example. Consider ‘lupus.’  Pericarditis, the inflammation of the sac aound the heart is a very painful condition that affects many lupus sufferers. The pain from pericarditis can be so severe: that “it feels like I’m having a heart attack!” However, our treatment of that acute pain is severely lacking because we are also concerned, and rightly so, about the abuse of opioids.

But, should the treatment of chronic pain which is real pain, be compromised because of the fear of addiction? As you’ll see, not treating chronic pain can have severe consequences.

Doctors and nurses have been trained to recognize ‘drug seeking’ behavior and also how to recognize those in real pain. Then, it was decided by the healthcare community, that more attention needed to be placed on the subject of pain.

It was decided that pain was whatever the patient says it was, and ‘pain’ became the fifth vital sign in the late 90s to early 2000s. At this time, there was a push to recognize and adequately treat pain. So, the reason for not treating chronic pain well has got to be more than not understanding that pain recognition was a real problem.

In the face of the current opioid crisis, it seems to me to be quite logical that one reason that pain is inadequately treated is ‘fear:’ Fear of using opioids due to fear of addiction in the current opioid crisis. However, the pain experienced by chronic pain sufferers is real. They have often tried oral pain meds and because they have taken them often, they have developed a tolerance for some medications,

It came to my attenton a few minutes ago that recently, a gal had so much pain from her pericarditis that finally felt that her pain would be adressed now that the had an ally in a good doctor.

She followed his plan of care to the letter and they developed a good rapport. Finally, she had a partner in her care! Unfortunately, he tried all things in his arsenal and they weren’t effective; however, she knew that he would become more aggressive in his treatment and pain management plan and prescribe whatever medication necessary until he found something to relieve her pain. By this time she had endured hours of pain, was getting desperate and looking forward to relief.

Then her doctor lowered the boom with this statement, “I can’t do more,”  which, loosely translated meant “I won’t do more because I’m concerned that my prescriptive ability will be limited by the state.”

In the meantime, the patient’s feelings of desperation turned to feelings of aloneness and this in turn turned to action on her desperation. She grabbed her husband’s gun and opened fire in her mouth. Was the Hippocratic Oath of ‘First, Do No Harm’ served in this case? Was this the Hippocratic Oath run amuck?

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