As part of National Spine & Pain Centers continued efforts to address the nation’s opioid crisis, Dr. Anish S. Patel recently authored an article in Practical Pain Management on how physicians and patients must work together to prevent opioid abuse.
Dr. Patel noted that prevention begins with communication. “A thorough conversation with the patient is always the first step to safe opioid therapy,” he wrote. This includes covering:
- When and why opioid therapy is appropriate
- The kind, dosage and duration of the medication, as well as plans for follow-up and discontinuation of that medication
- Assessment of a patient’s risk for abuse
- Potential complications of chronic opioid use
This conversation must be documented with a written opioid agreement. “These are to be read and signed by the patient to ensure the patient understands the importance of complying with physician orders,” Dr. Patel wrote.
Physicians must also inform their patients about opioid testing requirements and other tools to ensure proper use of the medication. These include prescription drug monitoring programs, methods for detecting inappropriate prescribing and referral to addiction specialists when appropriate.
With the current focus on opioid abuse, Dr. Patel noted that some patients who have safely and appropriately used opioids for an extended period of time now fear that they will no longer be able to take their medications. This presents another opportunity for physicians to have a candid conversation with their patients.
“These patients should be permitted to continue their medication as long as it is clinically the lowest effective does that provides sustained relief,” Dr. Patel said. But physicians should also discuss other options that may be available, including tapering off opioid medication or having it delivered intrathecally as is often done for cancer patients.
Dr. Patel also encourages physicians, both in office settings and hospitals, to consider non-opioid analgesics, anti-inflammatories and minimally invasive procedures such as peripheral nerve blocks to help patients control their pain. National Spine & Pain Centers physicians are pain specialists who are skilled in a number of interventional treatments such as kyphoplasty and radiofrequency neurotomy that can actually eliminate the source of pain so that medications are not even required.
Effective opioid management requires a commitment from both the doctor and patient to recognizing the risks and benefits of these medications, Dr. Patel wrote. The ultimate goal should be to develop an “exit strategy” that will enable the patient to achieve pain relief without narcotics.