Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition _ ________________
Recently passed Utah law requires a prescriber to check the database before the first time the prescriber issues a Schedule II or III opioid prescription, unless the prescription is for three or fewer days, the prescriber has prior knowledge of the patient’s prescription history, or it is a post-surgical prescription written for a duration of 30 days or less. A prescriber is also required to check the Utah Clinical Guidelines on Prescribing Opioids for the Treatment of Pain database or similar records if the prescriber is repeatedly prescribing Schedule II or III opioids to a patient (Utah Code Ann 58-37f-304(2)(b). The following controlled substances are not required to be reported in the CSD: • Prescriptions filled at federal facilities, such as military facilities. The Veteran’s Administration provides data in accordance to Public Law 115-86 115th Congress. • Prescriptions filled for individuals by pharmacies located outside the State of Utah. • Controlled substances administered in an inpatient setting. Acute Pain Recommendation 3: Consider Patient Risks Proactively consider initial and ongoing risks associated with opioid exposure based on age of the patient; history of substance use disorder; or psychiatric, physical, or medical comorbidities. The developing brain may be more susceptible to addiction when exposed to opioid medications and nonmedical use is more common among younger people. Those risks should be considered when prescribing to an adolescent [1]. Patients with mental health conditions are at increased risk for developing chronic pain; therefore, physicians should be cognizant of a patient’s psychological status and potential for substance use disorder. “Because psychological distress frequently interferes with improvement of pain and function in patients with chronic pain, using validated instruments such as the Generalized Anxiety Disorder (GAD)-7 and the Patient Health Questionnaire (PHQ)-9 or the PHQ-4 to assess for anxiety, post- traumatic stress disorder, and/or depression (205), might help prescribers improve overall pain treatment outcomes. Experts noted that prescribers should use additional caution and increased monitoring to lessen the increased risk for opioid use disorder among patients with mental health conditions (including depression, anxiety disorders, and PTSD), as well as increased risk for drug overdose among patients with depression [2]. The GAD-7 and PHQ-4 and PHQ-9 can be found in the Tools and Resources section.
5. National Conference of State Legislatures (NCSL). Prescribing Policies: States Confront Opioid Overdose Epidemic. June 30, 2019; http://www.ncsl.org/research/health/prescribing- policies-states-confront-opioid-overdose-epidemic.aspx. Accessed October 13, 2022.
UTAH CLINICAL GUIDELINES ON PRESCRIBING OPIOIDS FOR TREATMENT OF PAIN - JANUARY 2018
ACUTE PAIN OPIOID TREATMENT RECOMMENDATIONS
Acute Pain Recommendation 1: Use Non-pharmacologic and Non-opioid Pharmacologic Therapies as Alternative Treatments to Opioids Opioid medications should only be used for the treatment of acute pain when the severity of the pain warrants that choice and after determining that other non-opioid pain medications or therapies are either contraindicated or will not provide adequate pain relief. Unless contraindicated, non- opioid analgesics, adjuvant analgesics (e.g., anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids) and non-pharmacologic therapies (e.g., cognitive behavioral therapy, physical therapy) are the preferred method of treatment of acute pain. Most acute pain can be effectively and safely treated with non- pharmacologic or non-opioid therapies (e.g., acetaminophen, non-steroidal anti-inflammatory drugs [NSAIDs], or therapies such as exercise, or specific stretching) rather than opioid medications, which have less desirable adverse effects. Care should be taken to assure that use of opioid pain treatment does not interfere with early implementation of functional restoration programs, such as exercise and physical therapy.
Acute Pain Recommendation 2: Check the Utah Controlled Substance Database (CSD)
The CSD should be checked before prescribing opioids for acute pain to learn more about the patient’s controlled substance prescription history at the inception of a patient- prescriber relationship and when prescribing opioids. Document the results of this review in the patient’s record. The Utah Division of Occupational and Professional Licensing (DOPL) maintains the CSD Program. Access to the data is provided to authorized individuals by going online at www. dopl.utah.gov. Individuals who are licensed to prescribe controlled substances in Utah or staff assigned by the prescriber must register with DOPL to use the CSD. A prescriber can designate one or more employees who can access the CSD on the prescriber’s behalf. Information from the CSD may be included in a patient’s medical chart or file and shared with other medical professionals authorized to receive the information pursuant to Utah law and HIPAA.
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