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    What can physicians do to help curb the opioid crisis?

     

    Pain management contracts

    Patient pain management contracts are another tool doctors often use both to help patients and ensure they aren’t selling or giving away opioid medications. Such agreements generally require the patient to come in regularly for urine tests and pill counts. 

    Robert Raspa, MD, a primary care physician in Jacksonville, Florida, says his practice instituted them about a decade ago after a nearby medical center stopped accepting patients with Medicaid coverage.

    “All of a sudden new patients started showing up saying they needed their medications renewed,” he recalls. “We knew it was a dangerous situation we weren’t prepared to handle, and one way we responded was to institute these contracts.”

     

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    Marla Kushner, DO, a primary care physician in Chicago, focuses solely on helping patients with opioid dependencies or addictions, and usually with the aid of medication-assisted therapies such as Suboxone (bupenophrone). Her contracts include the requirement that patients attend 12-step programs, such as Alcoholics or Narcotics Anonymous, as part of their treatment. It’s part of her larger conviction, which she emphasizes to patients, that success in  managing addiction, or overcoming dependency, ultimately is up to them. 

    “I always tell them, ‘you don’t have a choice to have this disease, but once you know you do, you can decide what you’re going to do about it. Are you going to take your medication, are you going to work a program?’ That’s where the choice comes in,” she says.

    Addiction as a chronic disease

    Like many physicians, Kushner has had to drop patients who break the terms of their contracts, such as requesting refills by telephone rather than coming to the office. But she doesn’t drop patients if they relapse, due to her belief that addiction is a chronic disease, and needs to be managed like other chronic diseases such as diabetes.

    “A diabetic eats a piece of chocolate cake. That doesn’t mean we’re going to kick them out of the practice,” she points out. “We work with them to figure out what we could have done differently to keep their blood sugar under control.”

    The same approach should apply to people with opioid addictions, she says. “I want patients to feel if they relapse this is a safe place for them to talk about it so we can come up with a different plan,” she explains. 

      Educating patients, both about the effects of opioids and the importance of not allowing other people to have access to them is also important. That’s especially important for families with children, says Sandra Adamson Fryhofer, MD, an Atlanta, Georgia internist. “I’ve had some patients whose kids have gotten hooked on drugs from something they found in the family’s medicine cabinet,” she says. 

     

    BLOG: Isn't it time for a 21st Century Pain assessment?

     

    Because of that, she tries to make clear to all her patients the importance of keeping medications out of the reach of children and teens. “I want them to be aware that other people may have access to what’s in their medicine cabinet,” she says.

    Kushner stresses the importance of informing the public about the true nature of addiction but with a different emphasis. “I think it would be helpful to educate people more that opioid addiction is a disease, not just a weakness and not something people choose to go through,” she says. 

    The importance of thorough workups

    A further important element in battling opioid abuse, doctors say, is a thorough and detailed work-up of new patients seeking opioid prescriptions. 

    Next: Understanding the systemic challenges

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    • Anonymous
      don't force nurses to ask about pain
    • Anonymous
      don't force nurses to ask about pain

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