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:
- 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.
- 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.
- 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.
- 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.