Risk Management and Mitigating Risk Opportunities for Opioid Prescribing

All clinicians are ethically obliged to prescribe responsibly and cautiously to diminish the potential for opioid diversion and to help minimize the growth of the current opioid abuse epidemic. Podiatric physicians should establish procedures to better control and limit opioid prescription and develop analgesic regimens to treat pain. The main purpose and goal of this review is to present data congruent with clinical, medical, and legal reports for allowing an appreciation of the possibility of the risk assumed when ordering and prescribing opioids within the podiatric medical profession. First, the concept and process of risk management, illustrated using a root cause analysis approach, is introduced, and application of these principles specifically to opioid prescribing is presented. Then, several examples found in both the medical and legal literature documenting the reasons for opioid prescription risk are presented. Finally, mitigating strategies for safe opioid prescribing are offered so that mitigation of opioid harm can be possible and realized by the lower-extremity specialist. Risk management strategies and tools to mitigate opioid harm, lessen opioid adverse effects, and reduce opioid deaths are presented narratively and graphically.