Pain Practice: The Changing Landscape for Primary Care

Primary care practitioners need to be aware of some changes relating to the use of opioids to treat pain.  State-licensing board guidelines are changing. There’s some new and good legislation regarding the use of naloxone kits to help people who might be at risk for opioid overdose or even respiratory events related to the use of opioids.  Providers also need to be aware of new criteria for risk assessment and referrals to pain specialists.

Practitioners need a system that ensures that they are actively current on licensing board requirements and clinical guidelines relating to the long-term use of opioid therapy.  They’ll want to have a notebook that includes some information from the federal government.  The Substance Abuse Mental Health Services Administration has a fabulous kit for prescribers, and patients and family members that relate to opioid overdose issues.  There is a lot of good information in there that helps the provider fulfill the informed consent requirement when opioids are prescribed.  It’s also useful information to use to train their staff. And if there was ever an investigation and a need to engage an attorney, this little handbook of clinical material could be a good reference resource.

Most importantly, the amount of education that a provider can give to a patient on these issues is super critical.  By educating the patient, you are putting them on notice that they do have responsibilities--safe use of the medicine, safe storage of it, safe disposal, asking questions, getting engaged and talking about any adverse event they might have with the medication.  Some breathing problems might trigger something in a provider to say ‘hey, let me help you with this additional medicine just in case something goes wrong.  I’m not labeling you an abuser or an addict.  I simply want to care for you and give you a tool like an epinephrine pen you would have if you were an asthmatic, give you this tool in case you feel like you might be having an overdose event.’  That education, that sharing in responsibility, and that recognition of patient responsibility is critical. Providers that do that are really taking steps in good faith to help protect their patients.