Has the Pendulum Swung Too Far? Ethical Issues in the Conservative Use of Prescription Opioids.

The opioid crisis is an undeniable public health emergency that has impacted far too many for far too long. The irresponsible prescription and use of opioids has caused, and continues to create, harm to a large number of people; yet what irresponsible means in this situation has been insufficiently examined. One especially pressing concern is that the efforts put in place to combat the opioid epidemic have yielded a new problem: leaving patients unnecessarily in pain due to exceedingly defensive prescribing practices. We argue that the overly conservative use of opioid drugs following the opioid epidemic, though rooted in good intentions, often crosses the line of nonmaleficence, causing undue pain to the patient when means of prevention are readily available. In following the core medical tenet of beneficence, providers should not feel guilty about prescribing these therapeutics, because in preventing undue pain, a physician is acting for the benefit of their patient. In this paper, we consider the ethical implications of conservative opioid prescription, arguing that it is in violation of those core medical ethical principles. In doing so, we rely on empirical data and ethical theory in support of our claims, offering a multimodal solution to aid both providers, and the public health system as a whole that ultimately aims to avoid harm and benefit the patient in opioid related circumstances.