Ask any primary care physician or hospitalist (and many subspecialists) and I wager that patient opiate demands represent their most frustrating recurrent issue. We are clearly caught between those who demand that we relieve pain and those who point fingers at us for excessive opiate prescribing.

Many people like how opiates make them feel. Many people become addicted easily to opiates. It seems that they use knowledge of the pain imperative to ask us for more opiates.

We clearly have a conundrum. We can receive criticism when we do not address the patient’s pain to the patient’s satisfaction, and we can receive sanctions when we prescribe opiates too freely.

We also have another serious problem. Once a patient becomes an opiate addict (often when a patient starts with a legitimate need for pain relief), then when we do not prescribe more opiates they may turn to illegal opiates – heroin.

Heroin use jumps in US as painkiller addicts switch drugs

The CDC reported that over 8,000 people died from a heroin-involved overdose in 2013, nearly twice the number of deaths seen just two years earlier.
Federal officials cited a number of factors causing the rise in heroin use.
As authorities have cracked down on prescription drug abuse in recent years, users who have become addicted to the pills have switched to heroin. The drug is often cheaper and more easily available.
The amount of heroin being brought into the US has also increased, driving down the cost of the street drug.

So what are we to do? This is a most serious public health issue that we must face patient by patient. And we hate the problem. We like patients, but fulfilling their opiate demands is not really a good idea.

Any good suggestions?