Table 4.

Clinicians’ perceptions of the risks of opioids.

First, do no harm

“You’ve got methadone, oxycodone, and morphine in your urine. I’ve been prescribing the morphine. It’s not safe and it’s against clinic policy. First do no harm.”

“I’m worried about you. You’ve got methadone in your urine and I’m prescribing oxycodone. You could overdose. I’m worried about your safety.”

Community harm

“I’m a provider for a community. I don’t just serve patients. I serve a whole community. Giving someone pain meds that they divert and then sell puts other people in the community at risk. So I want to keep the community safe, not just the patient safe, and then [keep] me safe too.”

Medicolegal risk

“We’ve had patients in this practice die, and God knows how many people have died that we don’t know about. That’s on my license, on my prescription, and that’s not okay.”

“Doctors are under fire for prescribing these medicines and patients that overdose, their families are coming back and suing doctors ‘Why did you prescribe that dangerous medicine to my [family member].’ ”

Naloxone (Narcan)

“I did [prescribe Naloxone] for one patient who I knew was a heroin addict … but it hasn’t occurred to me to prescribe to people who have crack problems. It doesn’t occur to me to give them Narcan.”

“There’s a lot of questions [about naloxone] … who is going to be there to give it to the patient? I guess another argument can be that [it] gives them more of a reason to go full blown on the narcotics, because they know they have an out with naloxone to bounce back.”