title: Controlling pain and reducing misuse of opioids:  ethical considerations.
abstract: OBJECTIVE
  To help family physicians achieve an ethical balance in their opioid prescribing practices.
  
  
  METHODS
  MEDLINE was searched for English-language articles published between 1985 and 2011. Most available evidence was level III.
  
  
  RESULTS
  It is essential to follow practice guidelines when prescribing opioids, except when another course of action is demonstrably justified. In addition, when considering the appropriateness of an opioid prescription, with its many ethical implications, the decision can be usefully guided by the application of the ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice. As well, it is essential to keep current about legal and regulatory changes and provincial electronic registries of opioid prescriptions.
  
  
  CONCLUSIONS
  Physicians need to ensure that their patients' pain is properly assessed and managed. Reaching optimal pain control might necessitate prescribing opioids. But the obligation to provide pain relief needs to be balanced with an equally important responsibility not to expose patients to risk of addiction and not to create opportunities for drug diversion, trafficking, and the addiction of others. Basic ethical principles can provide a framework to help physicians make ethically appropriate decisions about opioid prescribing.
authors.affiliation: Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ont. jkotalik@lakeheadu.ca
authors.forename: Jaro
authors.initials: J
authors.lastname: Kotalik
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005194:Family Practice / Q000941:ethics*; D006801:Humans; D057970:Inappropriate Prescribing / Q000941:ethics*; D008297:Male; D059408:Pain Management / Q000009:adverse effects*; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid