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States have tried to respond to the opioid overdose epidemic, and one of the more recent innovations has been a focus on dosage thresholds and subsequent triggers. Once a chronic pain patient, for example, reaches 120 mg morphine equivalency per day, it triggers a particular action or recommendation...
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It’s been said that patients who are on higher doses of morphine equivalence per day are at higher risk of opiate induced respiratory depression and death. But the truth is that patients who are on very high doses of opioids may be very much sicker and they may be at a higher risk of death for other...
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With the institution of the Affordable Care Act, we really don’t know what’s going to happen to the future of federal funded medicine. And with the implementation of ICD-10, reimbursement to pain practitioners may be delayed by as much as three to six months with a reduction in the income of the...
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The relationship between addictive behavior and prescription pain medication is a really complex one. It’s almost always hard to predict. There are some obvious clues, like a previous history of substance abuse, or potential clues such as a family history of substance abuse, or maybe some...
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Methadone is not just your classic opioid. It also has NMDA receptor activity which has been postulated to help decrease the development of opioid tolerance. It’s also postulated to have more of a benefit in patients with neuropathic pain. Methadone is available in tablet or solution formulations...
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There’s a robust body of literature on the comorbidity of depression, anxiety and chronic pain. Approximately 50 percent of patients who suffer from chronic nonmalignant pain suffer from some degree of depression. With respect to pain patients and suicidal ideation the prevalence is anywhere between...
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Many prescribers are faced with ethical and legal dilemmas stemming from patients who they suspect might be diverting their prescription drugs. And it’s going to be difficult for prescribers to detect this deception because even police officers have difficulty doing so. And if a physician or...
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When faced with a problem patient, it’s important to remember the physician-patient relationship, and to keep that front and center. Prescribers should avoid labeling and not avoid the issue. State-licensing boards are going to encourage the provider to talk to the patient about a potential problem...
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A panel of legal and compliance experts discuss some of the issues confronting prescribers of controlled substances in the management of patients who may be abusing and/or diverting their medications. How should clinicians negotiate the terrain between confronting suspicious patient behavior and...
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Most state licensing boards specify that if you’re in a chronic opioid prescribing situation, you have to do a history and physical evaluation, write up a treatment plan, be sure there is informed consent, and a treatment agreement. If it’s a new patient that you don’t know well, think about a slow...