From the Guidelines
Prescribing opiates to a patient who is under charges for drug trafficking is strongly discouraged due to the high risk of diversion, misuse, or enabling addiction, and non-opioid alternatives should be considered first. According to the CDC clinical practice guideline for prescribing opioids for pain [ 1 ], opioids should not be considered first-line or routine therapy for subacute or chronic pain, and the risks of opioid therapy, including opioid use disorder, overdose, and death, should be carefully weighed against the potential benefits.
When considering pain management for a patient under charges for drug trafficking, it is essential to prioritize non-opioid alternatives, such as:
- NSAIDs (ibuprofen, naproxen)
- Acetaminophen
- Adjuvant medications like gabapentin or duloxetine for neuropathic pain If opiates are deemed clinically necessary after exhausting alternatives, strict safeguards should be implemented, including:
- Using the lowest effective dose for the shortest duration possible
- Requiring frequent in-person visits
- Conducting random urine drug screens
- Checking prescription monitoring databases before each prescription
- Considering a formal pain management contract It is crucial to document thoroughly the clinical reasoning, risk-benefit assessment, and all discussions with the patient, and to consult with addiction specialists or pain management colleagues for guidance [ 1 ]. This approach balances the ethical obligation to treat legitimate pain against the risks of diversion, misuse, or enabling addiction, particularly given the patient's legal situation which suggests potential for drug misuse or diversion.
From the FDA Drug Label
Assess each patient's risk for opioid addiction, abuse, or misuse prior to prescribing buprenorphine hydrochloride, and reassess all patients receiving buprenorphine hydrochloride for the development of these behaviors and conditions Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol addiction or abuse) or mental illness (e.g., major depression). Patients at increased risk may be prescribed opioids such as buprenorphine hydrochloride, but use in such patients necessitates intensive counseling about the risks and proper use of buprenorphine hydrochloride along with frequent reevaluation for signs of addiction, abuse, and misuse.
Prescribing opiates to a patient under charges for drug trafficking is a high-risk situation. The patient's risk for opioid addiction, abuse, or misuse is increased due to their history of drug-related charges.
- Intensive counseling about the risks and proper use of opiates is necessary.
- Frequent reevaluation for signs of addiction, abuse, and misuse is required.
- Consider the patient's personal and family history of substance abuse and mental illness when making a decision. It is crucial to weigh the potential benefits of prescribing opiates against the risks of addiction, abuse, and misuse in this patient population 2.
From the Research
Prescribing Opiates to Patients Under Charges for Drug Trafficking
- There is no direct evidence to support or refute the practice of prescribing opiates to patients who are under charges for drug trafficking 3, 4, 5, 6, 7.
- However, studies suggest that exercise and physical activity may be beneficial for individuals with opioid use disorder, potentially reducing cravings, anxiety, and depression 4, 7.
- In terms of pain management, opioids may be necessary for severe pain, but their use should be carefully considered and monitored, especially in patients with a history of substance abuse 5, 6.
- The pharmacokinetics and pharmacodynamics of opioids in different populations, including neonates, infants, and children, have been studied, providing guidance for safe and effective use 6.
- While there is no specific guidance on prescribing opiates to patients under charges for drug trafficking, healthcare professionals should exercise caution and consider the individual patient's needs and circumstances when making treatment decisions.