States step in on opioid prescribing

This issue covers such topics as legislative issues regarding prescribing, potential overdoses by patients taking narcotics, and a new way to look at overall health.

The opioid crisis in the United States has reached the point where state legislators feel they need to get involved, passing laws limiting how much of the drugs can be prescribed and to whom. But legislators aren't physicians, and there has been pushback from those in the medical field about how far such laws should go and whether they should be passed at all. Some of the concerns expressed include the potential for lack of appropriate pain control for patients and a tendency of physicians to back off prescribing opioids altogether. Charlotte Huff looks at the state laws that have been passed so far and talks to physicians in some of those states about how the medical community worked to modify the laws before passage and how individual doctors are making them work in clinical practice.

Another story also deals with opioids and other ways to lessen risk for overdose in patients who take them. A recent study found that patients who overdose on prescription opioids and end up in the hospital are very likely to eventually receive a new opioid prescription after discharge, even from the same physician. In addition, the risk of overdose can be heightened when opioids are combined with other drugs, especially benzodiazepines (both drug classes were the subject of a recent “black-box” warning from the FDA detailing risks involved when they are taken together). Physicians working to achieve optimal pain control for their patients should manage expectations for pain relief, learn the warning signs of potential addiction, and work with other clinicians to find solutions, experts said.

A thorough assessment of patients' health can involve more than just physical well-being. For example, a recent study comparing the traditional medical model with a comprehensive model examining medical, physical, psychological, functional, and sensory factors found that the number of older adults considered “healthy” declined when more indicators beyond the physical were considered. Read more about determining social factors affecting patients' overall well-being and ways to address them in clinical practice.

Most young physicians today belong to the generation known as “millennials,” or those born between early 1980s and 2000, a group considered by some to be entitled and self-centered. But are these descriptors fair? In medicine, for example, some older physicians may see their younger counterparts as less respectful of hierarchy and more willing to hand off their patients, but others feel that environmental and individual factors, including changes in training and technology, have a larger effect than merely age alone. Staff writer Mollie Durkin talks to millennials , Gen X-ers, and baby boomers to get their perspectives on the “cross-cover mindset,” work-life balance, and other factors that could be creating the appearance of a generational divide.

Do you think your generation impacts the way you practice medicine? Let us know.


Jennifer Kearney-Strouse