Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ont.
Can Fam Physician. 2012 Apr;58(4):381-5, e190-5.
To help family physicians achieve an ethical balance in their opioid prescribing practices.
MEDLINE was searched for English-language articles published between 1985 and 2011. Most available evidence was level III.
It is essential to follow practice guidelines when prescribing opioids, except when another course of action is demonstrably justified. In addition, when considering the appropriateness of an opioid prescription, with its many ethical implications, the decision can be usefully guided by the application of the ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice. As well, it is essential to keep current about legal and regulatory changes and provincial electronic registries of opioid prescriptions.
Physicians need to ensure that their patients' pain is properly assessed and managed. Reaching optimal pain control might necessitate prescribing opioids. But the obligation to provide pain relief needs to be balanced with an equally important responsibility not to expose patients to risk of addiction and not to create opportunities for drug diversion, trafficking, and the addiction of others. Basic ethical principles can provide a framework to help physicians make ethically appropriate decisions about opioid prescribing.
帮助家庭医生在开具阿片类药物处方时实现伦理平衡。
检索了 1985 年至 2011 年间发表的英文医学文献。大多数现有证据为 III 级。
除了有明显理由证明采取其他行动外，在开具阿片类药物时遵循实践指南至关重要。此外，在考虑开具阿片类药物处方的适当性时，鉴于其涉及许多伦理问题，应用有利、不伤害、尊重自主权和公正等伦理原则可以为决策提供有益指导。此外，还必须了解有关法律和法规的变化以及省级阿片类药物处方电子登记册。
医生需要确保患者的疼痛得到适当评估和管理。实现最佳疼痛控制可能需要开具阿片类药物。但是，提供疼痛缓解的义务需要与同样重要的责任相平衡，即不使患者面临成瘾风险，不创造药物转移、贩运和他人成瘾的机会。基本伦理原则可以为医生提供一个框架，帮助他们就阿片类药物处方做出符合伦理的决策。
