The Opioid Prescribers Group

The Opioid Prescribers Group was founded two years ago to address the alarming rise in drug overdose deaths in Southern Oregon and to provide a standard of care for treating chronic pain.

Some of its recommendations:

Assessment

  • Review patient's medical history, including records from previous providers.
  • Administer a physical exam to determine baseline function and pain.
  • Determine whether prior attempts were made to address the pain with non-narcotic treatments.
  • Be sure the diagnosis is appropriate for opioid treatment.
  • Do a psychosocial and risk assessment to determine risk of medication abuse and psychiatric co-morbidity.

Nonopioid options

  • Create a plan of treatment that incorporates interventions without the use of opiate medication.
  • Help patients improve their lifestyle with exercise and weight loss.
  • Incorporate therapies such as support/education groups, case management, psychotherapy, physical therapy and occupational therapy.
  • Determine which medical interventions are appropriate, such as pharmacological, procedural, surgical.

Opioid treatment

  • Proceed with caution.
  • Perform a urine drug test prior to prescribing.
  • Check for evidence of possible misuse.
  • Require patient to sign a treatment agreement.
  • Agree on and document treatment goals.
  • At every visit, assess for changes in function and pain, evaluate progress on treatment goals, assess for aberrant behaviors and assess for adverse side effects.

Reassessment

  • If no improvement or if aberrant behavior or adverse side effects are observed, stop and reassess the treatment.
  • Re-evaluate your treatment plan and seek help from specialists if you are: Prescribing more than 120 mg of morphine-equivalent doses without obvious functional improvement; prescribing opioids with benzodiazepines; prescribing more than 40 mg of methadone a day.

The guidelines can be found at www.SouthernOregonOpioidManagement.org.


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