Opiophobia – Your doctor's fear of prescribing opioids - (12/25/2018)

By Dr. Ron Gasbarro

Cliff came into the pharmacy looking quite upset. He handed the pharmacist a prescription. “What is this for?” he asked. The pharmacist explained that it was an antidepressant. “But I am not depressed! I am in pain! I need some strong painkillers!” The pharmacist has seen it before. The war against opioids is practically at full throttle. Tens of thousands are dying each year from not only pain pills, but also the cheaper and often adulterated heroin to which people can turn when they cannot obtain narcotics legally. Of those who opt for heroin, 80% start out with pills. Prescribers are under so much pressure to curb their handing out prescriptions for narcotics that those who really need them cannot obtain them. 

A drunk driver crashed into Cliff’s car six months earlier. He was propelled through his windshield and was left with severe head and back injuries. These injuries resulted in relentless chronic pain, leaving Cliff unable to work or, at times, even to walk. He went to a half dozen healthcare professionals who prescribed him anti-inflammatory medications, such as ibuprofen, and antidepressants in an indirect attempt to quell the patient’s pain. Cliff saw three, albeit, desperate options: alcohol, heroin, or suicide. 

Due to the intense regulation of controlled substances, the US government at both the federal and state level has caused an alarming effect on prescribers’ eagerness to write for powerful medications that would ease the pain of these patients. No prescriber wants to lose his/her license for writing a prescription that another health caregiver could just as easily write. Consequently, patients who need these medications suffer unnecessarily. This fear of prescribing opioid analgesics is known as “opiophobia.” It is the opposite of overprescribing. Either healthcare providers refuse to prescribe opiates at all, or they prescribe far too little — at doses too low to adequately alleviate the pain. This phenomenon of opiophobia is widespread in the US, and it results in patients with moderate-to-severe intractable pain being unable to obtain the necessary medication to live a tolerable life.

The pharmacist knew of two other patients who could not obtain the pain meds they needed. Linda was a nurse who needed OxyContin® to ease the chronic bone pain caused by leukemia. She was able to get the drug for about two years. During that time, she resumed her life and went back to work. Suddenly, the doctor cut her off, telling her he had become fearful he might attract the attention of the Drug Enforcement Agency (DEA). He switched her to a less controversial drug that made her feel woozy and high.

Another man had horrible pain from lung cancer. His doctor gave him one prescription for morphine. When the patient came back to get another prescription, the doctor refused. The patient said, “I am coming back here with a rope. If the prescription is not written, I will hang myself from the tree outside your office.”

Cliff finally found another healthcare provider who was willing to prescribe the opioid medications required for him to function. Subsequently, that same prescriber came under investigation for his use of opiates to treat his patients’ pain. Eventually, the doctor will have to make a choice, and Cliff will be the one who suffers. He will be forced to make other, more unsavory choices. When will the difference between drug-seeking behavior and drug-needing desperation be realized?

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at 


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