The Importance of Informed Consent in Opioid Drug Prescribing
Who doesn’t want to make informed decisions? Have you ever paid for a product or service on a whim and then regretted it after finding out the product or service wasn’t really what you wanted? You probably would not have made the purchase had you been more informed on what you were buying.
This logic transfers into the health spectrum. We must make informed decisions on how to best maintain our health. To get the correct information to make those decisions, most patients turn to their primary care physicians. That is how the practice of informed consent came about.
Informed consent is essential in the medical space, especially considering the harmful side-effects in many of today’s doctor-prescribed drugs. Unfortunately, even though informed consent is a critical component of the doctor-patient relationship, this practice is not utilized nearly as much as it should be.
What Is Informed Consent?
What is informed consent, exactly? Medicine Net defines informed consent as the following: “The process by which a patient learns about and understands the purpose, benefits, and potential risks of a medical or surgical intervention, including clinical trials, and then agrees to receive the treatment or participate in the trial. Informed consent generally requires the patient or responsible party to sign a statement confirming that they understand the risks and benefits of the procedure or treatment.”
Practical Pain Management offers a free guide to doctors on how to provide informed consent to their patients. In it are recommendations such as, “Sitting at eye level with the patient,” and “Giving the patient a sense that this is an important conversation and that you have time to devote to having it,” and “Educating the patient on the medication, including the associated risks and anticipated benefits,” and “Asking the patient to demonstrate his or her understanding of the risks and benefits of the medication, as well as his or her part of the agreement, by repeating back the information.”
“Only 9% of the 2,553 clinical decisions made during these encounters met the criteria for completely informed decision-making.”
That is all fantastic advice. Unfortunately, it isn’t adhered to nearly enough. A study published in the U.S. National Library of Medicine found that the practice of informed consent is severely lacking in the U.S. medical sphere. According to the study, “Research suggests that physicians rarely meet even minimal standards of disclosure for the purposes of obtaining informed consent. For example, Braddock and colleagues looked at 1,057 physician-patient encounters involving 59 primary care physicians and 65 general or orthopedic surgeons. Only 9% of the 2,553 clinical decisions made during these encounters met the criteria for completely informed decision-making.”
The Centers for Disease Control and Prevention on Opioid Prescribing
When our country experiences a significant health threat, we look to the Centers for Disease Control and Prevention for guidance. The CDC is the federal organization in charge of preventing, addressing, reducing, and eliminating major health threats.
As one can imagine, the CDC has quite a lot to say about the opioid crisis, particularly as pertains to pharmaceutical opioids. In addition to delivering advisements on informed consent, the CDC has also published and distributed recommendations to doctors on safe opioid prescribing practices. These include discussing risks and alternatives with patients (which is by itself a part of informed consent). Two of the CDC’s guidelines are included below, for context:
- “Opioids are not first-line therapy. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.”
- “Discuss risks and benefits. Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.”
Doctors need to ensure that they are genuinely applying the principles of informed consent. Doctors should also be quite conservative in opioid prescribing. Even if a patient gives his doctor total willingness and total informed consent to receive an opioid prescription, that doctor should still be extremely conservative in the type of opioid he prescribes, how much of it he prescribes, and for how long he prescribes it for.
What Else Do Doctors Need to Inform Their Patients About?
So far, we have discussed two areas of prescribing that the medical field should focus on. One is the subject of informed consent, and the other is the need to be extremely conservative in opioid prescribing in general. What about a third area?
Another area of informed consent that gets almost no attention is the practice of informing patients on alternatives. Yes, there are alternatives to opioid pain relievers for the treatment of physical pain symptoms.
The first part of informed consent is informing patients about the risks of opioids. But the second part (also not done enough) pertains to advising them on alternatives that they can use to treat their pain. These would be alternatives that would provide pain relief and which would do so without carrying the significant risk for addiction that goes along with opioid pain relievers. Some brief examples would be chiropractic care, SAM-e supplements, ginger, turmeric, willow bark, etc.
If Your Loved One Is Addicted to Painkillers
If you have a loved one who is already addicted to opioid painkillers, then your loved one is past the point of benefiting from informed consent, at least on that particular drug. Informed consent is a preventative measure, designed to help prevent people from getting hooked on potentially addictive drugs. If your loved one is already hooked, it’s time for them to seek help from a residential drug and alcohol rehab center.
Don’t delay or procrastinate in helping your loved one. Don’t try to find some substitute drug. Don’t settle for outpatient meetings or support groups. Opiate addiction is a life or death matter. The only way to treat it safely and effectively is with the help of a long-term, residential drug rehab center.
Sources:
- https://www.medicinenet.com/script/main/art.asp?articlekey=22414
- https://www.practicalpainmanagement.com/resource-centers/opioid-prescribing-monitoring/have-real-conversation-informed-consent-vs-
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307558/
- https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf
- https://www.health.harvard.edu/pain/chiropractic-care-for-pain-relief
- https://medlineplus.gov/druginfo/natural/955.html
- https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/9-supplements-arthritis.php
®