_____________________________________________________ Responsible and Effective Opioid Prescribing
19. Prescribing of opioids is strongly discouraged for patients abusing illicit drugs. These patients are at extremely high risk for abuse, overdose, and death. If opioids are prescribed to such patients, a clear and compelling justification should be present. 20. During initial opioid titration, practitioners should re-evaluate patients every 1–4 weeks. During chronic therapy, patients should be seen at least every 3 months, more frequently if they demonstrate higher risk. 21. Practitioners should consider prescribing naloxone for home use in case of overdose for patients at higher risk, including: a. History of overdose (a relative contraindication to chronic opioid therapy). b. Opioid doses over 50 MMEs/day. c. Clinical depression. d. Evidence of increased risk by other measures (behaviors, family history, PDMP, UDS, risk questionnaires, etc.). The recommended dose is 0.4 mg for IM or intranasal use, with a second dose available if the first is ineffective or wears off before EMS arrives. Family members can be prescribed naloxone for use with the patient. 22. All practitioners are expected to provide care for potential complications of the treatments they provide, including opioid use disorder. As a result, if a patient receiving opioids develops behaviors indicative of opioid use disorder, the practitioner, when possible, should assist the patient in obtaining addiction treatment, either by providing it directly (buprenorphine, naltrexone, etc. plus behavioral therapy) or referring them to an appropriate treatment center or provider willing to accept the patient. Discharging a patient from the provider’s practice solely due to an opioid use disorder is not considered acceptable. 23. Discontinuing Opioid Therapy a. If lack of efficacy of opioid therapy is determined, safe discontinuation of opioid of therapy should be performed. b. If evidence of increased risk develops, weaning or safe discontinuation of opioid of opioid should be considered. c. If evidence emerges that indicates that the opioids put a patient at the risk of imminent danger (overdose, addiction, etc.), or that they are being diverted, opioids should be immediately discontinued and the patient should be treated for withdrawal, if needed. Exceptions to abrupt opioid discontinuation include patients with unstable angina and pregnant patients. These patients should be weaned from the opioid medications in a gradual manner with close follow-up. 24. Current HIPAA Guidance for the Sharing of Protected Health Information with a Patient’s Family Members and Loved Ones Irrespective of Patient Wishes. Interpretive guidance from the U.S. Department of Health and Human Services Office of Civil Rights, indicates that HIPAA regulations allow health professionals to share health information with a patient’s loved ones in emergency or dangerous situations such as opioid overdose. HIPAA allows health care professionals to disclose some health information without a patient’s permis- sion under certain circumstances, including: in cases where the patient is incapacitated or unconscious, or where a serious and imminent threat to a patient’s health or safety exists. For example, a doctor whose patient has overdosed on opioids is presumed to have complied with HIPAA if the doctor informs family, friends, or caregivers of the opioid abuse after determining, based on the facts and circumstances, that the patient poses a serious and imminent threat to his or her health through continued opioid abuse upon discharge.
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MDWI1625
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