Blanket “no narcotics” policy not an option
Some physicians – concerned about feeling
obligated or pressured to prescribe narcotics to
patients who ask for them – feel that it is easier
to simply have in place a general ‘no narcotics’
policy. But the College says that such a move is
not part of the practice of good medicine.
“Having a blanket ‘no narcotics’ policy
removes the physician’s ability to exercise his or
her clinical discretion when considering whether
or not to prescribe narcotics and controlled
substances to a particular patient. Instead of
having such a policy, it is advised that physicians
use their professional judgment to determine
whether prescribing narcotics and controlled
substances is appropriate for each patient.
Physicians have no obligation to prescribe
ties, sleep, relationships, enjoyment of life, etc. The
higher the number, the worse the function.
With that baseline, it’s easier to assess the effectiveness of interventions. Consider a patient who describes his pain as 9 out of 10, and can’t walk up the
stairs or play with his children. “If I give medication,
and you say your pain is still a 9 but you’re walking
2 km a day and enjoying life more, that’s a huge victory,” says Dr. Murphy. ““There are simple tools to
measure function. And we continue to monitor that
throughout their care.”
Dr. Murphy gets many consults for people on highdose opioids. If they score high on functional interference and are on high-dose opioids, the narcotics
just aren’t working. So that opens a discussion on
strategies. The functional score isn’t perfect, says Dr.
Murphy, “but it gives us an indication if we’re winning or losing.”
It would be ideal if opioids are given only to people
who have functional improvement and no risk. The
reality is that opioids are a tool, he says, and any
tool can be a problem if you don’t use it at the right
any drug, including narcotics and