Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition _ ________________
3. Opioid Basics contains information for patients: https:// www.cdc.gov/opioids/patients/index.html 4. Understanding the Epidemic: https://www.cdc.gov/ drugoverdose/epidemic/index.html UTAH RESOURCES: 1. The prescription drug monitoring program in Utah is called the Controlled Substance Database and can be found here: https://dopl.utah.gov/csd/index.html. Controlled substance prescribing and dispensing are tracked here, and may be accessed by healthcare providers for information on individuals’ prescription drug use [3]. 2. Utah-specific tools and tamper-resistant requirements for prescriptions can be found here: http://www.health.utah. gov/prescription/tools.html 3. The Talk to Your Pharmacist outreach program encourages pharmacists to start a conversation with patients who have been prescribed an opioid and can be found here: https:// cdn.ymaws.com/www.upha.com/resource/resmgr/ Talk_To_Your_Pharmacist_Tool.pdf 4. The Know your Script campaign (https://knowyourscript. org) is designed to prevent and reduce the misuse and abuse of prescription pain medications in Utah by providing information and strategies regarding safe use, safe storage, and safe disposal. 5. The Utah Department of Health-developed “Stop the Opidemic” website (https://www.opidemic.org/), a public education campaign for Utah residents, includes signs and symptoms of an opioid overdose, a list of common opioids, and a directory of support groups and rehabilitation centers. 6. Drug Take-Back events are held twice a year through partnerships with the Utah Attorney General’s office and other state and national bodies. The “Utah Take Back” website (https://attorneygeneral.utah.gov/tag/utah-take- back/) provides general information about substance abuse and event locations. 3. PATIENT RECORD DOCUMENTATION FOR CONTROLLED SUBSTANCE AND OPIOID PRESCRIBING Utah guidelines recommend the Pain Assessment and Documentation Tool to set and monitor treatment goals [2]. A detailed patient medical record should be completed on initial assessment and maintained at every subsequent clinical visit. It should include [4]: • History of present illness including information regarding current and past treatments • Characteristics and intensity of pain • Medical, social, and psychiatric history, and review of systems
• Results of physical exam, diagnostic, and imaging tests • Risk assessment for substance use disorder: may utilize screening instrument • Rationale for opioid treatment • Signed copies of the treatment agreement and informed consent. • Description of and response to all treatments provided (date, type, dose, quantity) • Prescription of naloxone provided and rationale • All prescription orders for opioids and other controlled substances • Instructions to patient, including addressing nonadherence and ongoing discussions of risks vs. benefits with the patient and significant others • Assessments of progress toward achieving therapeutic goals • Notes on consultations with specialists • Presence of adverse events and how addressed • Adherence to prescribed therapies, including results of urine drug tests and prescription database checks • Notes on continuing, revising, or terminating treatment • Authorization for release of information to other treatment providers The informed consent form typically includes information about [2]: • Prescriber’s policies and expectations • Likelihood of tolerance developing • Possible drug interactions • Limited evidence of the benefit of long-term opioid therapy • Specific reasons for adapting or discontinuing opioid therapy • That patients should not expect complete relief of pain, and improved function is the main criterion for continuing opioid treatment Recommendations of what an opioid treatment agreement should contain include patient agreement to [2]: • Take medications as prescribed • Have regular office visits • Refrain from use of mood-modifying drugs that have not been prescribed • Participate in assessments of other recommended pain treatment programs • Help self in progress toward treatment goals with healthy habits (e.g., smoking cessation, weight control, exercise)
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