Can Opioids Still Be Prescribed Effectively and Safely in the Era of Federal Scrutiny?

Meeting highlights from Spine Summit: 33rd Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves

As part of a seminar of panelists addressing perioperative pain management, Carl W. Stopper, APN-C, presented Opioid Use in an Era of Federal Scrutiny during Spine Summit. Mr. Stopper is Director of Nursing at Atlantic Neurosurgical Specialists, in Morristown, New Jersey.

Underlying Reasons for Recent Federal Scrutiny of Opioid Prescribing
Overdose deaths involving prescription opioids have quadrupled since 1999. From 1999 to 2015, more than 183,000 patients died in the US of overdoses related to prescription opioids.

In 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication, enough for every US adult. Opioid prescriptions per capita increased by 7.3% from 2007 to 2012. Opioid prescribing rates increased more by physicians in family practice, general practice, and internal medicine than by those in other specialties.

pharmacist holding a prescription and a medicationIn 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication.In March of 2016, the Centers for Disease Control and Prevention issued its Guidelines for Prescribing Opioids for Chronic Pain for primary care prescribing of opioids for chronic pain other than at the end of life. Topics addressed in the guidelines include when to initiate opioid therapy, as well as opioid selection, dose, duration, follow-up, discontinuation, risk assessment, and the harms of opioid use.

At the Practice Level: Responsible Prescribing of Opioids
Dr. Stopper pointed out several actions physicians implement in their practices to address the issue of opioid addiction. The actions include: participate in a prescription monitoring program, check it at every visit and keep meticulous records. Include a psychological function and substance abuse history when taking a history and perform a physical examination.

Use an opioid risk tool to assess potential risk of substance abuse. Devise a treatment plan, and prescribe proportionately. For example, acute pain should only last five days and can be treated without opioids.

Obtain informed consent using a pain management contract. Ask patients to sign a controlled prescription drug agreement. Perform random or routine urine drug screening in all patients with chronic pain. When possible, prescribe electronically. Instruct patients to use a single pharmacy, and communicate and develop an acquaintance with that pharmacist.

Responsible Prescribing: What Not to Do
Mr. Stopper provided an extensive list of what not to do in conjunction with prescribing opioids. Some suggestions were obvious “don’t do,” such as don’t prescribe to a family member.

  • Controlled drugs should not be prescribed in large quantities
  • Prescribe at intervals consistent with legitimate medical treatment
  • Do not use prescription pads/paper for taking notes
  • Do not sign blank prescriptions

Conclusion
Chronic pain can be relieved effectively and safely, and the epidemic of opioid addiction reversed with careful implementation of expert guidelines in daily practice.

Updated on: 02/08/18
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