The opioid crisis has led to myriad state laws restricting physician opioid prescribing.1 This increased scrutiny, combined with heightened attention to other controlled substances like benzodiazepines and gabapentinoids implicated in some overdoses,2 has heightened anxiety for many physicians around prescribing these medications. Though these tightened standards may be appropriate, we have observed that many physicians lack the comfort and skill needed to set firm yet compassionate boundaries around prescribing controlled medications. When faced with direct requests for these medications, physicians may feel caught between their impulse to avoid harm on one hand, and their desire to heal, to satisfy patient preferences, and to avoid conflict on the other. The discomfort resulting from these competing impulses can drive physicians across specialties to unconsciously respond in ways that may undermine the physician-patient alliance, especially if they react dismissively without expressing empathy.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: David Marcovitz, MD, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN 37212 (firstname.lastname@example.org).
Published Online: February 9, 2022. doi:10.1001/jamapsychiatry.2021.4284
Conflict of Interest Disclosures: Dr Marcovitz has equity in Better Life Partners LLC and Silver Pines LLC. Dr Suzuki reported grant K23DA042326 from the National Institute on Drug Abuse. No other disclosures were reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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