Continuity clinic can be painful. The patients are often non-adherent, the no-show rate is high, and the paperelectronic records hybrid system is less than ideal. Added to that is the stress of caring for patients with a variety of medical issues and the burden of being expected to prescribe opiates for them. Given all of the difficulties associated with opiate prescribing, including the potential for abuse, limited continuity with providers, and poor overall adherence to medical advice, it has been proposed that these medications should no longer be prescribed at our resident clinic, and many residents support this plan. However, implementing a blanket moratorium on opiate prescribing would violate several of the fundamental principles of our medical training.

According to U.S. Food and Drug Administration data, approximately one hundred million new opiate prescriptions were written in the year 2009. Of these prescriptions, general internists were responsible for writing about fifteen percent of them, including both immediate and extended release formulations.1 So, if opiate use is so fraught with problems, why are physicians prescribing so many of them? This is likely because they are some of our most effective medicines and many of our patients need immediate relief from acute pain.