The study of overdose deaths in West Virginia by Hall and colleagues in this issue of JAMA1 revealed that opioid analgesics contributed to 93% of those deaths and most of these potentially avoidable deaths occurred in younger persons (aged 18-44 years). These disturbing findings are certain to raise questions about physician prescribing practices, the safety and adverse effect profiles of opioid medications, and the appropriate management of pain. These findings also raise several important questions for physicians who are trying to balance their duty to relieve pain in individual patients and their obligation to prevent the broader public health problems of addiction and overdose death.
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