Unused narcotics are a risk to children and the community, so be sure to talk about proper disposal. “Every patient you give an opioid to, instruct them how to dispose of excess ones,” said John Pang, MD, a head and neck surgery resident at UC San Diego Health and a coauthor of the JAMA Otolaryngology–Head & Neck Surgery paper regarding opioid use among patients with head and neck cancer. Your local pharmacist can help you and your patients figure out how to safely dispose of unneeded opioids.
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December 20175. Patients Who Want Refills Should Be Referred to Pain Management Specialists
A patient who continues to complain of pain and wants additional opioids after an initial prescription should be seen in the office. “Number one, you need to make sure that there are no complications that are causing pain,” Dr. Gavi said. “Do a good exam and listen to the patient.”
If no physical explanation for the continued pain can be found, Dr. Gavi has a conversation with the patient. “I say, ‘I can’t explain why you have this much pain; that’s unusual. I don’t have a good explanation for your pain, so I would rather you talk to a pain specialist,’” he said.
Consider involving a pain specialist in cases involving any patient who seems to have more pain than expected. “We don’t understand why some patients have more pain than others,” said Joshua Smith, MD. a chronic pain physician at Greenville Health System in South Carolina. “Maybe there is some drug-seeking behavior, but it’s not fair to our patients to chalk it all up to that.” A pain specialist can help identify and untangle factors that may be causing increased pain, and develop a multi-disciplinary treatment plan.
Jennifer Fink is a freelance medical writer based in Wisconsin.
Key points
- Increasingly, clinicians and patients are recognizing that prescription opioid use can lead to opioid addiction.
- Prescribing practices are starting to change, but slowly.
- Currently, there isn’t much uniformity regarding opioid prescribing practices, even within the same medical practice.
Highlights of the CDC 2016 Opioid Prescribing Guidelines
- Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
- Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
- Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that increase the risk of overdose.