Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ • In allegations of inappropriate pain management, the Board will not take disciplinary action for deviation from “best practices” when medical records show reasonable cause for deviation.
relevant pharmacologic and clinical issues in the use of opioid analgesics and should obtain sufficient targeted continuing education and training on the safe prescribing of opioids and other analgesics as well as training in multimodal treatments. The Guidelines focus on the general overall safe and evidence-based prescribing of opioids and treatment of chronic, non-cancer pain, with the specific limita- tion and restriction that they do not operate to create any specific standard of care. A variety of strategies may be used to achieve the goals of the Guidelines, including the patient’s level of pain, preferences of the clinician and the patient, available resources, and other concurrent issues. The Guidelines do not encourage the prescribing of opioids over other pharmacological and nonpharmacological means of treatment. Pain management should be viewed as essential to both the quality of medical practice and to the quality of life for patients who suffer from pain. The Guidelines are not intended for the treat- ment of acute pain, acute pain management in the perioperative setting, emergency care, cancer-related pain, palliative care, or end-of-life care. They apply most directly to the treatment of chronic pain last- ing more than three months in duration or past the
The model policy additionally stated that physicians would not be sanctioned on the sole basis of medi- cally legitimate opioid prescribing ( Table 8 ) . In 2015, the FSMB appointed a workgroup to review and analyze the original policy document as well as other state and federal policies on the prescribing of opioids in pain treatment, including advisories issued by the CDC and the FDA [113]. In April 2017, the FSMB adopted the Guidelines for the Chronic Use of Opioid Analgesics , an update to the original model policy that includes recommenda- tions identified by the workgroup. The stated goal of this document is to provide state medical and osteopathic boards with an updated guideline for assessing physician management of pain, so as to determine whether opioid analgesics are used in a manner that is both medically appropriate and in compliance with applicable state and federal laws and regulations [113]. The FSMB 2017 Guidelines communicate the mes- sage that pain management is an important area of patient care, integral to medical practice; and that opioid analgesics may be necessary for pain control. In order to implement best practices for responsible opioid prescribing, clinicians should understand the
time of normal tissue healing [113]. ASSESSING OPIOID BENEFIT AND RISK OF MISUSE
In deciding whether to prescribe an opioid analgesic for chronic pain, clinicians should perform, and document in the record, an assessment of the poten-
CHARACTERISTICS OF APPROPRIATE AND INAPPROPRIATE OPIOID PRESCRIBING
Medically Legitimate Pain Management and Prescribing Based on sound clinical judgment and current best clinical practices Appropriately documented Demonstrable patient benefit Occurs during the usual course of professional practice A legitimate physician-patient relationship exists Prescribing or administration appropriate to diagnosis Careful follow-up monitoring of patient response and safe patient use Demonstration of adjustment to therapy, as needed Documentation of appropriate referrals, as necessary
Inappropriate Pain Management and Prescribing Inadequate attention in initial assessment to clinical indication or patient risk of opioid problems Inadequate monitoring Inadequate patient education and informed consent Unjustified dose escalation without sufficient attention to risks or alternative treatments Excessive reliance on opioids, especially high-dose opioids, for chronic pain Failure to use risk assessment tools
Source: [10]
Table 8
26
MDMS1526
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