When Pain Medicine is Scarce, Don’t Ignore the Problem: Considerations in the Ethical Allocation of Scarce Opioids

Document Type

Article

Publication Date

12-2025

Publication Title

Neuroethics

Abstract

At the beginning of the COVID-19 pandemic, health care agencies and those helping to guide their decision-making spent significant time and energy developing mechanisms to allocate scarce medical resources. Driven by some reported shortages, some agencies considered whether standard allocation schemas could be applied to the distribution of scarce opioids, specifically parenteral opioids. The problem is that medical prognosis, which is the primary factor used in standard allocation schemas, is inappropriate for making allocation decisions involving pain. We describe a different type of allocation schema for an opioid shortage based primarily on patient reports of pain and describe optional secondary criteria for consideration. The result is a starting point for how to address the many challenges associated with opioid scarcity. Importantly, we argue that some deception, in the form of withholding information from patients about the implementation and details of a pain lottery, is ethically permissible to address unique challenges that arise for the treatment of pain in conditions of scarcity

Volume

18

Issue

3

First Page

53

DOI

10.1007/s12152-025-09627-z

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