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Setting Limits With Controlled Substances—The Role of Motivational Interviewing to Increase Comfort

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

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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Article Information

Corresponding Author: David Marcovitz, MD, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN 37212 (david.marcovitz@vumc.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.

References
1.
Chua  KP , Brummett  CM , Waljee  JF .  Opioid prescribing limits for acute pain: potential problems with design and implementation.   JAMA. 2019;321(7):643-644. doi:10.1001/jama.2019.0010PubMedGoogle ScholarCrossref
2.
Khan  NF , Bykov  K , Glynn  RJ , Barnett  ML , Gagne  JJ .  Co-prescription of opioids with other medications and risk of opioid overdose.   Clin Pharmacol Ther. 2021;110(4):1011-1017. doi:10.1002/cpt.2314PubMedGoogle ScholarCrossref
3.
Rubak  S , Sandbaek  A , Lauritzen  T , Christensen  B .  Motivational interviewing: a systematic review and meta-analysis.   Br J Gen Pract. 2005;55(513):305-312.PubMedGoogle Scholar
4.
Hirschtritt  ME , Olfson  M , Kroenke  K .  Balancing the risks and benefits of benzodiazepines.   JAMA. 2021;325(4):347-348. doi:10.1001/jama.2020.22106PubMedGoogle ScholarCrossref
5.
Dunhill  D , Schmidt  S , Klein  R .  Motivational interviewing interventions in graduate medical education: a systematic review of the evidence.   J Grad Med Educ. 2014;6(2):222-236. doi:10.4300/JGME-D-13-00124.1PubMedGoogle ScholarCrossref
6.
Miller  WR , Rose  GS .  Toward a theory of motivational interviewing.   Am Psychol. 2009;64(6):527-537. doi:10.1037/a0016830PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

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:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

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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