Whenever federal and state law conflict, the more restrictive law applies. The Prescription Drug Abuse Policy System (PDAPS), funded by the National Institute on Drug Abuse, tracks key state laws related to prescription drug abuse here: https://www.pdaps. org/.
The CDC has issued a practice guideline for using opioids to treat patients who have chronic pain and do not have an active malignancy or need palliative or end-of-life care. 64 The guideline defines long-term opioid therapy as use of opioids on most days for greater than three months. Authors of the guideline state that its strictures should not be used to deny clinically appropriate opioid therapy to patients but, rather, to help HCPs in primary care consider all treatment options with an eye to reducing inappropriate opioid use. 133 and assess pain, mental-health, social, substance, and opioid risk as previously described. A list of items to document in the patient record is shown in Box1. 23,64,78,86,131,144 Medical records should be kept up-to-date and be legible so as to be easily reviewed.
Initiating or continuing long-term opioid therapy The HCP may consider a trial of long-term opioid therapy as one therapeutic option if the patient’s pain is severe and ongoing or recurs frequently, diminishing function or quality of life, and is unrelieved or likely to be unrelieved by non-opioid therapies. 78 To initiate a trial or continue opioid therapy, the HCP should complete the initial exam and diagnostic procedures
Box 1: Items to Perform and Document in the Patient Record When Prescribing Opioid Therapy for Chronic Pain 23,64,78,86,131,144 1. Signed informed consent. 2. Signed opioid treatment agreement(s). 3. Pain and medical history: • Chief complaint. • Treatments tried and patient response. • Past laboratory, diagnostic, and imaging results. • Comorbid conditions (e.g., medical, substance-use, psychiatric, mood, sleep). • Social history (e.g., employment, marital, family status, substance use). • Pregnancy status or intent, contraceptive use. 4. Results of physical exam and new diagnostic and imaging tests: • Review of systems. • Pain intensity and level of functioning. • One or more indications for opioid treatment. • Objective disease/diagnostic markers. 5. Results of opioid risk assessment prior to prescribing opioids: • Clinical interview or any screening instruments. • Personal history of SUD, mental health disorder. • Family history of SUD, mental health disorder.Co-management or treatment referral for patients at risk for SUD. • Treatment or referral for patients with active OUD. • Treatment or referral for patients with undiagnosed depression, anxiety, other mental health disorders. 6. Treatment goals for pain relief, function, quality of life. 7. Treatments provided: • With risk-benefit analysis after considering available nonpharmacologic and non-opioid pharmacologic options. • All medications prescribed (including the date, type, dose, and quantity). • All prescription orders for opioids and other controlled substances whether written or telephoned. 8. Prescription of naloxone, if provided, and rationale. 9. Results of ongoing monitoring toward pain management and functional goals. SUD = substance-use disorder OUD = opioid-use disorder; PDMP = prescription drug-monitoring programs; UDT = urine drug testing Informed consent
Patients started on opioid therapy for chronic pain should be informed of the potential risks and benefits. The most serious risk with any opioid is respiratory depression leading to death. Patients who have never taken opioids or whose medications or doses will be
changed should be counseled to expect sedation or other cognitive effects. An informed consent form should be signed by the HCP and the patient and retained in the medical record. Items recommended in informed consent include: 23,78,134
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Book Code: MDCO1025
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