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Since pain is underlying dx for most opioid use disorder, medically it is right for a doc, especially where addiction rx is rationed, to dx such patients' pain and rx same w safest and most effective non-disordering med that exists for severe chronic pain, while allowing these patients to live recovered lives and avoid OD, and allowing docs to free up rationed X's w which to save more lives. Further, it is, and should be ruled as medically right, in any case of severe chronic pain, for docs to begin rx with the most effective non-disordering med and prevent addiction instead of waiting till it happens. Re chronic pain-opioid use disorder, the whole "X" v. "non-X" semantic-obfuscation is a thing of little (or punitive/judgemental) minds. Trouble is, above is too medical to be grasped by DEA, and ASAM/SAMHSA alas strand docs without a single guideline/protocol to safeguard our doing what is medically right free of fear of punishment by a DEA operating w impunity under the DEA guideline/protocol that: once an addict always an addict, and dxing addicts as pain patients is just a way to cheat, and a doc rxing 101 suspectible addicts, pain or no, is a criminal
Brian your questions are important because many patients we see have 'lost control' of their rx'd opioids. They know. We are clear that pain pts can become opioid use disorded. So its just small seguay to 'this office (or I)treat people with both conditions.You will meet them at our required groups".
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