The Emotions with “High Dose” Opioids

Hey friends 👋🏻

First things first, I want to wish you a happy new year!

Reflecting on what I do as a pain management pharmacist, a lot of the consults I deal with involve opioid management, especially doses that are considered “high.” I’m using quotation marks here not to be politically correct, but to acknowledge that we don’t really have a working definition of high or low dose when it comes to opioids.

I say this because if I were to ask you,

What dose would you consider lisinopril 5mg?

You would likely say, “Yeah, that’s a low or starting dose.”

But if I were to ask what kind of dose you would consider oxycodone 15mg every 4 hours as needed, the answer quickly becomes debatable because it is very context dependent.

This is now my fourth year of practice. The longer I practice, the more I realize there are a lot of emotions tied to “high dose” opioids.

And these emotions are not only coming from patients. We have our own emotions too when the opioid dose goes beyond what we are comfortable managing.

Emotions around “high dose” opioids often need to be acknowledged. Building connection is something I find very crucial in opioid management, and you can’t build connection without addressing emotions.

So are you ready to hear some of the emotions I hear from patients?

• Uncertainty about whether their pain will be adequately managed and whether the opioid will be continued

• Mistrust from past encounters

• Being guarded because of prior mistreatment

• Helplessness because they don’t feel heard

• And simply, fear

And I can’t speak for all clinicians, but I’ve experienced a similar range of emotions myself

• Uncertainty about whether the dose will push risk to the edge

• Mistrust from previous incidents of dishonesty

• Being guarded because of all the red tape

• Helplessness because I need more help in this field

• Fear that I might have made the wrong decision

Almost the same set of emotions, but from very different perspectives.

So the next time you’re faced with a “high dose” opioid and you’re not sure what decision to make,

Ask yourself, what emotions am I feeling right now?

Then name the emotions.

Thank you for reading 🙇🏻

SP