Free educational tool offers advice on opioid prescribing

"Chronic opioid therapy always entails risks for patients, their families and the community, so vigilance and caution are essential," says a new educational piece on opioid prescribing.

The brief guide, Cautious, Evidence-based Opioid Prescribing, was produced by Physicians for Responsible Opioid Prescribing, a group seeking to "reduce morbidity and mortality resulting from prescribing of opioids and to promote cautious, safe and responsible opioid prescribing practices."

The four-page document includes myths and facts, and Dos and Don'ts about opioid prescribing and treating patients with pain. The authors include physicians, scientists, and patient/family advocates. Among them is Dr. Gary Franklin, the medical director for the Washington Department of Labor and Industries, and one of the speakers for the 21st National Workers' Compensation and Disability Conference® & Expo, produced by LRP Publications.

California: Researchers make pitch for payer access to monitoring program (03/04/13)
Prescription drug monitoring programs are underutilized tool (11/01/12)
Florida Legislature targets repackaged drug costs (01/30/12)
Report reveals startling increase in painkiller overdose deaths (12/01/11)
Ohio: Coordinated services program rule in the works (03/05/12)

"Opioids have significant risks besides addiction and misuse," the guide explains. "These risks include respiratory depression and unintentional overdose death; serious fractures from falls; hypogonadism and other endocrine effects that can cause a spectrum of adverse effects; increased pain sensitivity, sleep-disordered breathing, chronic constipation and serious fecal impaction, and chronic dry mouth which can lead to tooth decay."

Among the myths is that physical dependence only happens with high doses over long periods of time. "With daily opioid use, physical dependence and tolerance can develop in days or weeks," the guide says. Contrary to the notion that extended-release opioids are better than short-acting opioids for managing chronic pain, the guide says "extended-release opioids have not been proven to be safer or more effective than short-acting opioids for managing chronic pain."

Some of the dos and don'ts include:

Do explain that opioids are for time-limited use. With the first opioid prescription, set expectations that opioids should be discontinued when the pain problem is no longer acute.
Don't stock your patients' medicine cabinets with unused opioids. Limit all initial and refill prescriptions for acute pain.
Don't initiate chronic opioid therapy before considering safer alternatives such as primary disease management, cognitive-behavioral therapy, participating in pleasant and rewarding life activities, physical therapy, non-opioid analgesics, and exercise.
Do talk with patients about therapeutic goals, opioid risks, realistic benefits, and prescribing ground rules. Therapeutic goals should include increased activity and improved quality of life, not just pain relief. Patients should understand the full range of opioid risks and the limited benefits they can reasonably expect. The rules for safe and appropriate use of opioids need to be explicit, preferably documented in a written treatment agreement.
Do explain to patients that discontinuing opioids may be difficult. Patients can experience increased pain, insomnia, or anxiety when tapering from opioids. These unpleasant withdrawal symptoms can last for several weeks.

Read more at the WorkersComp Forum homepage.

August 30, 2012

Newsletter Sign-up