title: Putting a face on the prescription opioid epidemic: a case report.
abstract: Skilled clinical decision making in the diagnosis and treatment of chronic pain can create unique clinical and ethical challenges, particularly when opioid medications are involved. This report presents the case of a pregnant woman who sought treatment for an illicit opioid dependence, initiated by opioid analgesic treatment of chronic pain. While recognizing opioids' high level of effectiveness for pain relief, the case demonstrates the potential harms of opioid medications for particular patients. Using a framework informed by medical ethics, the report discusses how clinicians might assess the benefits and risks of opioid treatment by careful data gathering, knowledge of the evidence base and patient-centered, shared decision making.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. Electronic address: jacob.taylor@jhmi.edu.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Taylor
authors.affiliation: Johns Hopkins University School of Medicine.
authors.forename: Rebeccah A
authors.initials: RA
authors.lastname: McKibben
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, and Division of General Internal Medicine, Johns Hopkins University School of Medicine.
authors.forename: Matthew
authors.initials: M
authors.lastname: DeCamp
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Chisolm
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D006801:Humans; D009293:Opioid-Related Disorders / Q000209:etiology* / Q000628:therapy; D010098:Oxycodone / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000628:therapy; D063487:Prescription Drug Misuse / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone
keywords: Ethics; Opioid dependence; Prescription drug dependence