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26 - Opioid therapy in addicted patients:

background and perspective from the US

from 3 - Pain management

Published online by Cambridge University Press:  05 March 2012

Gail A. Van Norman
Affiliation:
University of Washington
Stephen Jackson
Affiliation:
Good Samaritan Hospital, San Jose
Stanley H. Rosenbaum
Affiliation:
Yale University School of Medicine
Susan K. Palmer
Affiliation:
Oregon Anesthesiology Group
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Summary

This chapter discusses opioid therapy for addicted patients based on the three cases studies. Differences in history, culture, healthcare systems, laws, and attitudes have significantly affected perspectives on the ethical management of opioid use between the US and the UK. The present state of affairs is that abuse of prescription opioids is more prevalent in the US than abuse of "street" heroin. Opioid treatment of pain has periodically come under intense scrutiny in the US, resulting in fluctuations between under- and overtreatment of pain. Fears of civil or criminal prosecution may unduly influence physicians in the US, placing self-interest ahead of the traditional prioritization of beneficence and respect for patient autonomy. Differences between the US and UK in healthcare provision additionally influence opioid prescribing. The paternalistic approach more predominant in universal healthcare systems is not appropriate in the US, thus producing ethical dilemmas for the US physicians.
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Clinical Ethics in Anesthesiology
A Case-Based Textbook
, pp. 154 - 160
Publisher: Cambridge University Press
Print publication year: 2010

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