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The most conservative addiction and overdose prevention policies and procedures can’t protect a primary care clinician from inheriting a patient who is taking high doses of opioids for chronic pain. In many cases, because of the patient’s limited resources or the limited number of specialists in the community, primary care clinicians are expected to satisfy the patient’s needs for specialty care, including pain management, mental health, and physical therapy. Although there is no perfect solution for clinicians faced with these challenging patients, the following recommendations can decrease the risk of overdose and increase the chance that patients can be transitioned to safer pain management:^*

According to the defense expert in the following case, patients who can’t or won’t engage in alternative treatments for their pain should not be prescribed pain medications as a matter of course. Consider how the overdose in the following case could have been prevented if the internist had followed the CDC opioid prescribing guidelines.

Concurrent use of opioid pain medications, benzodiazepines, antihistamines, antipsychotics, antianxiety agents, or other CNS depressants increases a patient’s risk for overdose.¹

With the prevalence of online self-diagnosis tools, the nature of physician-patient exchanges has shifted significantly. Search trends show that a large number of people research their symptoms online. In the U.S., one third of adults say that they have gone online in an effort to self-diagnose. 77% of these online searches begin with a major search engine such as Google, Yahoo, or Bing.¹ With Google reporting in 2016 that they handle more than 2 trillion searches per year,² and that 1% of all searches were related to medical symptoms,³ that’s more than 20 billion web searches for medical symptoms on Google alone every year.

Four federal tort reform bills that could affect medical liability law have passed the House of Representatives in the first session of the 115th United States Congress, with an additional medical liability bill having been introduced in the House.^1,4