Safe Opioid Prescribing and Controlled Substance Policies

The analgesic and “narcotic” properties of opioids have been recognized for hundreds if not thousands of years [1], but a full appreciation of their potential risks is a much more recent phenomenon. Appropriately, as the risks of overdose, addiction, and other adverse effects become clearer, the opioid prescribing regulatory landscape has become more restrictive. And yet, there are some patients who do benefit from opioid prescribing, and they should not be withheld when their potential benefits clearly outweigh potential harms for an individual patient. It is important for the primary care physician and, by extension, the medical residency continuity clinic to recognize this equipoise and approach opioid prescribing deliberately, rationally, and in a manner that prioritizes safety. In this chapter, we will explore this in more depth and guide the clinic director through this challenge.