Why the ethics of parsimonious medicine is not the ethics of rationing (Journal of the American Medical Association (2013) 309, 8, (773-774))

摘要

In addition, some industry-sponsored educational brochures suggest that physicians should ignore signs of opioid dependence in low-risk patients. For instance, some patients might not be considered at high risk of misuse even though they may use more opioids than prescribed (one definition of misuse). Some authors have stated that behaviors such as taking more opioids than prescribed may represent pseudoaddiction, a concept introduced in a case report in 1989 as "abnormal behavior developing as a direct consequence of inadequate pain management." However, this concept remains untested, without scientific studies validating diagnostic criteria or describing long-term clinical outcomes. Nonetheless, some pain societies have promoted this concept and suggest that some patients demonstrating behaviors typical of opioid addiction may actually require higher doses.