进退两难：医生能否在避免法律制裁的同时，合理开具阿片类药物以充分治疗疼痛？
BETWEEN A ROCK AND A HARD PLACE: CAN PHYSICIANS PRESCRIBE OPIOIDS TO TREAT PAIN ADEQUATELY WHILE AVOIDING LEGAL SANCTION?
作者信息
Dineen Kelly K, DuBois James M
出版信息
Am J Law Med. 2016;42(1):7-52. doi: 10.1177/0098858816644712.
Abstract
Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. Recent increases in opioid-related morbidity and mortality has reignited scrutiny of prescribing practices by law enforcement, regulatory agencies, and state medical boards. At the same time, the predominant 4D model of misprescribers is outdated and insufficient; it groups physician misprescribers as dated, duped, disabled, or dishonest. The weaknesses and inaccuracies of the 4D model are explored, along with the serious consequences of its application. This Article calls for development of an evidence base in this area and suggests an alternate model of misprescribers, the 3C model, which more accurately characterizes misprescribers as careless, corrupt, or compromised by impairment.
摘要
处方类阿片药物是医生治疗疼痛的重要工具，但如果患者或其他人不当开具或滥用，也会带来重大伤害风险。近期，与阿片类药物相关的发病率和死亡率不断上升，这再次引发了执法部门、监管机构和州医学委员会对处方行为的审查。与此同时，关于不当开处方者的主流4D模型已经过时且不够充分；该模型将医生不当开处方者归类为陈旧、受骗、残疾或不诚实。本文探讨了4D模型的弱点和不准确之处，以及应用该模型的严重后果。本文呼吁在这一领域建立证据基础，并提出一种替代的不当开处方者模型，即3C模型，该模型更准确地将不当开处方者描述为粗心、腐败或因损伤而受到影响。
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