Therefore, withholding the appropriate use of opioids from a patient who is experiencing pain on the basis of respiratory concerns is unwarranted. Despite well-documented evidence to the contrary , the fear of respiratory depression and resulting death permeates medical, legal and ethical discussions of pain management. Advocates will have to be educators and should never fall into the trap of accepting misinformation, however well-intentioned. It is very possible to kill an opioid-naive patient with opioids. The critical factor is the physician's intent and his or her adherence to good precepts of pain management.
Pharmacists often err on the side of caution.
Pharmacists are not trained to understand pain control. They have legal responsibilities under state and federal licensing regimes to refuse to fill prescriptions they believe are not for appropriate medical purposes. They often err on the side of caution and refuse to fill any opioid prescriptions, or do so with exaggerated scrutiny. Recent studies signal the possibility of racial profiling in filling and refusing to fill particular prescriptions. Pharmacies in poor inner-city neighborhoods may refuse to carry opioids because they fear robbery.