Tips for Steering Clear of Problems with Pain-Med Prescribing March 5, 2014 General narcotics/opioids, pain medication prescrbing 0 By Karen K. Davis, MA, CPHRM, Risk Management; NORCAL Mutual Insurance Company and the NORCAL Group The following tips will help you prescribe narcotics/opioids appropriately to patients in chronic pain: Obtain a thorough history and determine the specific cause of pain. Patients who request pain treatment should receive a comprehensive assessment aimed at finding a specific physical process to explain their pain. Stephen Richeimer, MD, Chief of Pain Medicine at the University of Southern California, says, “Assessment is a key issue. The history and physical examination provides the information that allows the physician to judge if the patient is legitimately in pain or if the patient is improperly seeking drugs.”1 Document well. Explanations in the patient’s medical record demonstrate that the patient was carefully evaluated and is being appropriately managed. Documentation verifies what modalities have been used to minimize pain, what is working, and what the overall plan of care is. Richeimer asserts: “Good record keeping is part of good medicine, and it is also your best protection from frivolous lawsuits.”1 Ask chronic-pain patients to agree to use a single pharmacy. Discussing pain treatment with the patient and getting the patient to agree to certain parameters associated with long-term pain management are mutually beneficial strategies: they help you avoid inadvertently supplying medication that might be diverted for street sale, and they reassure the patient in pain that he or she can count on obtaining needed medication. An especially useful rule is that the patient will use a single pharmacy for all pain medications. Make use of a written pain medication agreement with chronic-pain patients. A signed agreement by the patient that he or she will follow rules for obtaining pain medication will improve the likelihood of appropriate behavior by the patient. It discourages patients from seeking an unlimited supply of medication and helps staff members verify the legitimacy of refill requests. Monitor patients over time on their needs for and use of pain medication. Richeimer observes that patient trustworthiness “can only be assessed by monitoring the patient over time.”1 Berland and Rodgers recommend that all patients using opioids for chronic pain management “undergo urine drug testing before opioid therapy is initiated and then at least yearly unless patient behavior suggests the need for more frequent testing.”2 If you keep controlled substances in your office, establish a reliable process for safeguarding and reconciling such medications and for tracking their distribution. The federal Drug Enforcement Administration (DEA) requires physicians who administer or dispense controlled substances from their offices to have effective controls to guard against theft and diversion. Controlled substances must be stored in a securely locked, substantially constructed cabinet. Using a controlled substances inventory log can help you account for each and every dose of medication that goes through your office. These strategies are aimed at fostering appropriate pain management within the limits of professional practice. Furthermore, they can help physicians and staff consistently meet regulatory requirements on the management of pain medications. References 1. Richeimer S. Opioids for pain: risk management. California Society of Anesthesiologists Online CME Program. Available at: http://www.csahq.org/cme2/course.module.php?course=3&module=12 (Accessed January 11, 2013). 2. Berland D, Rodgers P. Rational use of opioids for management of chronic nonterminal pain. American Family Physician. 2012;86(3):252-258. Copyright 2013 NORCAL Mutual Insurance Company. All rights reserved. This material is intended for reproduction in the publications of NORCAL-approved brokers and sponsoring medical societies that have been granted prior written permission. No part of this publication may be otherwise reproduced, edited or modified without the prior written permission of NORCAL. For permission requests, contact: Jo Townson, CME Supervisor, at (800) 652-1051, ext. 2270. Comments are closed.
