__________________ Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition
Recommendation 3.3: Check the Utah Controlled Substance Database (CSD) The CSD should be checked at the inception of a patient- prescriber relationship and before prescribing opioids for chronic pain to learn more about the patient’s controlled substance prescription history. 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 CSD 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. 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 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). 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. 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. ESTABLISH TREATMENT GOALS AND A WRITTEN TREATMENT PLAN (4.1-5.2) CHRONIC PAIN RECOMMENDATION 4: GOALS AND TREATMENT PLAN Recommendation 4.1: Establish a Written Treatment Plan A patient-provider collaborative written opioid treatment plan should be established before opioid therapy and be reviewed and updated on a regular basis. Prescribers should tailor the treatment goals to the patient’s circumstances, cultural preferences, and to the characteristics and pathophysiology of the pain.
The pathophysiologic basis of the pain can help establish a prognosis for future improvement (or worsening) in function and pain, and should influence the treatment goals. Non- opioid treatment modalities should be included in the treatment plan whenever possible to maximize the likelihood of achieving treatment goals. Patient responsibilities include properly obtaining, filling, and using prescriptions as directed, and adherence to the treatment plan. The treatment plan is usually combined with a consent form. See Recommendation 5.1 for more information. A sample treatment plan can be found in the Tools and Resources section. Recommendation 4.2: Identify Measurable Treatment Goals Treatment goals should include measurable goals for function, quality of life, and improved pain control and should be developed jointly by the patient and prescriber. Prescribers have observed and adherence literature confirms that when patients are engaged in their own healthcare and assume responsibility for their rehabilitation, they are more likely to improve; and that when they participate in goal setting, they are more likely to achieve their goals. As with any other chronic illness (e.g., diabetes or heart disease), the prescriber should focus not just on pain control, but also on treating the patient’s underlying diseases and encouraging them to engage in the full spectrum of their health. These measures of improvement or worsening can be reported by the patient, family members, and/or employer. Permission to discuss the patient’s condition with these persons should have previously been obtained and documented. Recommendation 4.3: Maintain Accurate Patient Records Prescribers should obtain and document information about the patient’s treatment and history. Prescribers should document the treatment, interactions, and findings throughout their professional relationship with the patient. Providing thorough documentation throughout the treatment plan is essential for patient safety and prescriber protection. Recommendation 4.4: Plan to Modify or Discontinue Opioid Therapy The treatment plan and goals should explicitly include a plan to modify or discontinue opioid therapy when benefits do not outweigh the risks or when the patient fails to adhere to the agreed upon treatment plan. Prescribers should evaluate benefits and harms with patient within 1-4 weeks of starting opioid therapy or at the time of dose escalation; then continue to evaluate the benefits and harms of therapy with the patient every three months or more frequently if needed. If the benefits do not outweigh the harms of continued opioid therapy, prescribers should optimize other therapies and work with the patients to taper opioids to lower
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