The answer is No. This can be deadly. Never prescribe all
three drugs to one patient. If a patient overdoses on opioids, the doctor who
prescribed them can expect a review of records. Prescribing two of the three
drugs is even more risky.
If the combination is truly medically necessary, then
your rationale for prescribing them should be documented.
Never prescribe even one of these medications without
performing and documenting a thorough assessment and diagnosing a condition
that necessitates their prescription.
Always bear in mind that the patient may already be
receiving an opioid from one provider or a benzodiazepine from another provider
and/or a muscle relaxant from a third provider.
So, before prescribing any of these medications, tick off
these questions from your checklist:
1. Does my patient have a medical diagnosis that calls
for this medication?
2. Could the benefit be achieved with nonsteroidal
drug, or through physical therapy or other nonpharmacologic treatment?
3. Is there a risk of abuse in my patient?
4. Have I done a urine drug screen?
5. Do I have a written agreement with this patient
about the goals of care and the conditions under which I will prescribe this
medication?
6. Am I prepared to follow-up and assess whether the
medication is effective? Will I stop prescribing the medication and taper it
off if the patient is not improving?
7. Am I following opioid prescribing guidelines, and
am I following them?
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
