Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ VIGIL
The PADT is a clinician-directed interview, with most sections (e.g., analgesia, activities of daily living, adverse events) consisting of questions asked of the patient. However, the potential aberrant drug-related behavior section must be completed by the physician based on his or her observations of the patient. The Brief Intervention Tool The Brief Intervention Tool is a 26-item, “yes-no,” patient-administered questionnaire used to identify early signs of opioid abuse or addiction. The items assess the extent of problems related to drug use in several areas, including drug use-related functional impairment [121]. Involvement of Family Members Family members of the patient can provide valuable information that better informs decision making regarding continuing opioid therapy. Family mem- bers can observe whether a patient is losing control of his or her life or becoming less functional or more depressed during the course of opioid therapy. They can also provide input regarding positive or negative changes in patient function, attitude, and level of comfort. The following questions can be asked of family members or a spouse to help clarify whether the patient’s response to opioid therapy is favorable or unfavorable [123]: • Is the person’s day centered around taking the opioid medication? Response can help clarify long-term risks and benefits of the medication and identify other treatment options. • Does the person take pain medication only on occasion, perhaps three or four times per week? If yes, the likelihood of addiction is low. • Have there been any other substance (alcohol or drug) abuse problems in the person’s life? An affirmative response should be taken into consideration when prescribing. • Does the person in pain spend most of the day resting, avoiding activity, or feeling depressed? If so, this suggests the pain medication is failing to promote rehabilitation. Daily activity is essential, and the patient may be considered for enrollment in a graduated exercise program.
VIGIL is the acronym for a five-step risk manage- ment strategy designed to empower clinicians to appropriately prescribe opioids for pain by reduc- ing regulatory concerns and to give pharmacists a framework for resolving ambiguous opioid analgesic prescriptions in a manner that preserves legitimate patient need while potentially deterring diverters. The components of VIGIL are [124; 125]: • V erification: Is this a responsible opioid user? • I dentification: Is the identity of this patient verifiable? • G eneralization: Do we agree on mutual responsibilities and expectations? • I nterpretation: Do I feel comfortable allowing this person to have controlled substances? • L egalization: Am I acting legally and responsibly? The foundation of VIGIL is a collaborative pre- scriber/pharmacist relationship [125; 126]. Current Opioid Misuse Measure The Current Opioid Misuse Measure (COMM) is a 17-item patient self-report assessment designed to help clinicians identify misuse or abuse in patients with chronic pain. Unlike the ORT and the SOAPP- R, the COMM identifies aberrant behaviors associ- ated with opioid misuse in patients already receiving long-term opioid therapy [21]. Sample questions include: In the past 30 days, how often have you had to take more of your medication than prescribed? In the past 30 days, how much of your time was spent thinking about opioid medications (e.g., having enough, taking them, dosing schedule)? Pain Assessment and Documentation Tool Guidelines by the FSMB and the Joint Commission stress the importance of documentation from both a healthcare quality and medicolegal perspective. Research has found widespread deficits in chart notes and progress documentation with patients with chronic pain receiving opioid therapy, and the Pain Assessment and Documentation Tool (PADT) was designed to address these shortcomings [127].
32
MDMS1526
Powered by FlippingBook