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Long-term use of opioids may depend on the doctor who prescribes them

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March 27, 2017

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Comments

Dr Lynn Cintron
April 2, 2017

Dear Dr Weiner. Thanks for your article. There are other acute areas of medical care that opioid use is involved, ie surgery and recovery. As an anesthesiologist I try to utilize non opioids often and nerve blocks. I give patients opioids as needed. The surgeons may prescribe opioids post op. The doses have been cut down in the past year significantly. Surgery is an acute care setting. I believe my colleagues and I provide these medications appropriately, although there is room for improvement. However, I dont want to be penalized or put in the same category as a ‘high’ prescribing ER physician. So I agree, it often depends on the type of physician, but also his/ her training, the system or facility,
expectations, and financial incentives.
L. Cintron MD

GL
March 27, 2017

All these articles about the BAD of opioids make me sick. Only a few articles talk about the serious long term effects of NSAIDS, including death, (all of them) including long term effects of acetaminophen which is not a NSAID. I have unstable BP with the cause unknown. NSAIDS significantly raise my BP to danger levels. In some cases over 40 mmhg in less than two hours. I am plagued with leg neuropathy, chronic fibromyalgia, and flare up of arthritis, Oxycodone works wonders. I take on a as needed basis. For the record, whereas NSAIDS raise my BP, Opioids lower it making the Opioids the RX of choice. Depending on the type of discomfort, I can use hydrocodone, oxycodone with “NO” side effects.

Scott Weiner
March 27, 2017

Thank you for your thoughts. I tried to be as balanced as possible in the article, including acknowledging in the first paragraph the dual mandates clinicians have to both treat pain but also not contribute to the tragic number of opioid-related overdose deaths we are seeing (now as many as 4 lives lost every hour in this country). The rapid rise over the past decade in the number of deaths far exceeds that of NSAID-related mortality, which is most likely the reason for so much attention.

The article is addressed primarily at patients with acute pain – your situation is different and I agree that there is benefit to careful long-term use by some patients, as you kindly shared. Finally, I counsel my patients on the harms of NSAIDs as well and hope other prescribers do, too.

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