12/9/16 topic: Opioid management update
Action requested: Be prepared to manage patients on chronic opioid therapy whose health care provider is no longer able to practice.
The Board of Osteopathic Medicine and Surgery has suspended the license of Dr. Philip Matthews. Dr. Matthews operated a solo pain specialty practice in Bellevue. Displaced patients on chronic opioid therapy may call or visit your clinic or emergency department. The Washington State Department of Health has provided the following guidance that is useful anytime you care for patients on chronic opioid therapy.
• Some of these patients may have been on high doses of opioids for years and are likely physiologically dependent. If your evaluation suggests reduction or elimination of opioids is an appropriate strategy, slowly taper the dosage rather than abruptly stopping the opioids, which will lead to withdrawal.
• For patients taking opioids and benzodiazepines, consider tapering the high-dose opioids before addressing the benzodiazepine use.
• Prescribe naloxone for patients on greater than 90 MED/day or on combination therapy with other CNS depressants.
• Use the Prescription Monitoring Program to check for other prescriptions from different providers.
• Review frequently asked questions on Washington’s pain rules.
• Contact the patient’s healthcare plan if you need help finding a pain management specialist or case manager for your patient.
• Refer patients with a substance use disorder or patients who need an evaluation for a substance use disorder to an addiction medicine specialist or the Washington Recovery Help Line at 1-866-789-1511 (https://www.warecoveryhelpline.org).
Additional information regarding the management of chronic pain patients and use of the Prescription Monitoring Program is available at www.doh.wa.gov/pain. Also, the University of Washington recently established a new statewide pain consult line to provide clinical advice to healthcare providers caring for patients on complex pain medication regimens, particularly high dose opioids. Providers can access the UW Medicine Pain Consult line by calling 1-844-520-PAIN (7246) Monday through Friday 8:30 am – 4:30 pm.
Finally, the Centers for Disease Control & Prevention (CDC) is offering a webinar to help clinicians communicate more effectively with chronic pain patients. The training, at 11 AM Pacific on Tuesday, December 13, demonstrates how to apply principles of motivational interviewing and a six-step process that is patient-centered and supports clinical judgment when conflict arises. Presenters (including University of Washington faculty David Tauben, MD, and Joseph Merrill, MD, MPH) will review two case studies in which they will apply communication strategies, and provide examples of patient-provider dialogue. Free continuing medical education credit is available. You can participate via the webinar or phone (800-779-0686 passcode 3377346).
You can find my recent health alerts posted on the Provider pages of our website.