Opioids

[rknowle]

For those working in pain management: 

Have you changed your practices at all since the opioid epidemic has been getting so much media attention recently? If so, how? 

Do any of you have good strategies that you have developed for patients on long acting opioids who come in complaining of a new acute injury every visit (ex. tooth pain, minor MVA, laceration, fall, etc.) that they claim their usual medication is not controlling? 

At your clinics do patients typically see the same provider? If you are seeing another provider's patient how do you handle it? Do you change the treatment plan to fit how you practice or do you keep the same treatment plan since it is the first time you are seeing them? 

I appreciate any and all responses. Thanks

[cc56]

As an ER provider, I am very interested in this.  Also what do you do when the person comes in and says "the ER gave it to me!"  I have heard about contracts that say no pain meds from anyone, only the pain management. Is this truly in a contract or is every contract different?   

[CO PA-C]

I am sure that every contract is different. At our pain clinic we require patient's to call us if they receive a prescription from any other provider outside our office. At that point we can decide whether or not they should fill it (usually only make exceptions if they cannot be evaluated within the next 24 hours). If they filled an outside prescription without us knowing until we look at their PDMP then they violated the contract and typically move from being evaluated every month to every 2 weeks with random pill counts and UDS.

But yes, rule of thumb is absolutely no pain medication from any other provider.