When Can Physicians Fire Patients with Opioid Use Disorder for Nonmedical Use of Prescription Medications?

The opioid crisis has greatly increased the number of patients who are illegally injecting drugs while hospitalized for other conditions. Physicians face a difficult decision in these circumstances: when is it appropriate to involuntarily discharge or “fire” a patient with opioid use disorder for their continued nonmedical use of opioids? This commentary analyzes physicians’ responsibilities to their patients and argues that physicians should fire non-adherent patients only when every other option has been exhausted and the expected benefits of firing the patient outweigh the expected harms.