Prescriber-Patient Relationship

Beginning in the late 1990s, pain control became a patient’s rights issue. Prescribers started focusing on the symptomatic relief of pain based on patients’ self-reporting, rather than the clinical investigation of the causes. This new treatment regimen led to an exponential increase in opioid prescriptions from the prescriber’s aggressive treatment of pain. As a result, from 2000 to 2010 the number of opioid prescriptions increased from 164 million to more than 234 million, and between 1999 and 2014 there was a fourfold increase in opioid deaths (Dart et al. 2015). This has been termed the opioid epidemic and was recently declared a public health crisis.
The prescriber-patient relationship and the practice of medicine are based on the ethical principles of fidelity, respect for autonomy, beneficence, nonmaleficence, and justice (Kitchener, 1984). This relationship has been sacred since the days of Hippocrates; however, increased administrative requirements and closer scrutiny of opioid prescribing by state and federal authorities have
The prescriber-patient relationship is based on trust and creates an ethical obligation to consider the patient’s interests above their own self-interest (AMA 2017). Currently, prescribers appear to be most focused on the possibility that authorities will determine their prescribing practices of opioids are improper. The prescriber-patient relationship depends on fiduciary responsibility and trust. Patients trust that a prescriber will treat them, without judgment, even if they are unworthy. Likewise, they also trust the physician's main concern will be their well-being, without coming secondary to the physician's own self-interests. Without this trust, the prescriber-patient relationship does not