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Words That Work

Janine Bera, MD
Adult & Family Medicine, Kaiser Permanente
Sacramento County, CA

When I talk with my patients about opioids, I’ve found that words really count. How we talk about opioids affects the way that patients understand the risks and benefits. But using the right words is also about conveying empathy and showing that my patient and I are working together towards the patient’s goal.  The goal is probably not about being pain free, but about helping the patient do the things they want to do even if pain is present.

For example, when discussing tapering off opioids in my own practice, I’ve been using the word “habituated” – and it’s been working much better than “addicted or over using.” This helps to keep my patient listening and open to options. They don’t feel shameful or like a drug addict they have seen on TV. It helps them to understand that the reason they are using higher doses may be because of the way the drug works in their body and not that they are getting intoxicated. Saying they are habituated also helps them to understand withdrawal and to prepare for it.

In our practice, we have developed a tool for physicians talking to patients about chronic opioid therapy, from the initiative opioid therapy and creating a safety plan to tapering and, if needed, treatment. Here’s an excerpt from that tool:

Words that Work: Tools for Talking about Chronic Opioid Therapy Initiation

Make patient aware of why you are starting a trial of opioids:

Based on what we just discussed, we can start you on a trial of opioids.

The purpose of this is to help you function better, and hopefully reduce the pain.

Educate the patient about risks of opioids:

I wish that there was a medication that worked and did not have any side effects.

Opioids could help with pain, but they come with significant risks.

A small number of people can get mentally addicted to opioids even if they have never had addiction problems before.

When patients use more than prescribed, or if they take opioids with alcohol or sedating medications, opioids can cause overdose and death.

Establish treatment plan and invest in the end:

We are going to work together to determine if this treatment benefits you.

And just like with other treatments, if it is not working then we will make adjustments.

As your physician, I want to continue to work with you to treat this problem in the healthiest way possible.

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