● Authorization for release of information to other treatment providers.
These may include actual copies of, or references to, medical records of past hospitalizations or treatments by other providers; and, Discontinuing/tapering opioid therapy Weaning from opioids can be done safely by slowly tapering the opioid dose and taking into account several factors related to risk, symptom, and alternatives. Opioid Taper Plan and Calculator: ● “Interagency Guidelines on Opioid Dosing for Chronic Non-Cancer Pain” State of Washington Agency Medical Directors Group. 2010 Online: www.agencymeddirectors.wa.gov Aberrant drug-related behavior Prescribers and dispensers should use clinical judgment when aberrant drug-related behaviors are observed. Such behavior should be reported to the proper authorities and/or healthcare team as appropriate. Aberrant drug-related behaviors broadly range from hoarding medications to have an extra dose during times of more severe pain to felonious acts such as selling medication. These are any medication-related behaviors that depart from strict adherence to a prescribed therapeutic plan of care. Prescribers and dispensers should observe, monitor and take enhanced precautionary measures when a patient presents aberrant drug-related behaviors such as: ● Requesting early and/or repeated refills; ● Presents at or from an emergency department seeking high quantities of a prescription; ● Denied by other prescribers or dispensers; Practitioner Considerations Healthcare team: Consider that the patient may be receiving opioids from another prescriber. Contact the patient’s healthcare team when appropriate which may include the following: ● Physician; ● Specialist (pain, addiction, etc.); ● Dentist; ● Optometrist; ● Advanced Practice Nurse (APN); ● Podiatrist; ● Physician assistant; ● Mental and Behavioral Health Providers; ● Pharmacists; ● Area emergency rooms and urgent care clinics; ● Surrounding (within 5 miles) or historical pharmacies; and ● Veterinarian 22
● Pocket Guide: Tapering Opioids for Chronic Pain www.cdc.gov/drugoverdose/pdf/clinical_pocket_ guide_tapering-a.pdf ● Tapering Long-Term opioid Therapy in Chronic Noncancer Pain www.mayoclinicproceedings.org/ article/S0025-6196(15)00303-1/fulltext Withdrawal Symptoms Assessment: “Clinical Opiate Withdrawal Scale” The National Alliance for Advocates for Buprenorphine Treatment. Online at: www.naabt.org
● Presents what is suspected to be a forged, altered or counterfeit prescription; ● Forging prescriptions;
● Stealing or borrowing drugs; ● Frequently losing prescriptions; ● Aggressive demand for opioids; ● Injecting oral/topical opioids; ● Unsanctioned use of opioids; ● Unsanctioned dose escalation; ● Concurrent use of illicit drugs; ● Positive drug screen;
● Obtaining opioids from multiple prescribers; ● Obtaining multiple veterinary prescriptions for opioids for the patient’s animal(s); or, ● Recurring emergency department visits for chronic pain management 20 Prescribers and dispensers should be alert for subjective behaviors such as being nervous, overly talkative, agitated, emotionally volatile, and evasive, as these may be signs of a psychological condition that may be considered in a treatment plan or could suggest drug misuse. 21 Authorities: ● If the prescriber or dispenser suspects illegal activity, the matter should be referred to the Drug Enforcement Agency (DEA) and local law enforcement. ● If a prescriber or dispenser suspect illegal activity on behalf of another prescriber or dispenser, at a minimum, the matter should be reported to the appropriate licensing board. Prescribers and dispensers should be aware that: ● There is no legal obligation to prescribe or dispense a prescription; and, ● Colorado law strongly encourages prescribers and dispensers of opiate antagonists “to educate persons receiving the opiate antagonist on the use of an opiate antagonist for overdose, including but not limited to instructions concerning risk factors for overdose, recognition of overdose, calling emergency medical services, rescue breathing and administration of an opiate antagonist.” (Section 18-1-712(3) (b), C.R.S.)
Book Code: MDCO1025
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