Managing Opioid Overuse: A Case
Managing Opioid Overuse: A Case
This brought to mind the work that was published in 2007 on the development of an opioid renewal clinic. This was a model that was staffed by a nurse practitioner and a clinical pharmacist, and it was designed to aid opioid prescribers in the primary setting so that individuals who had demonstrated signs of substance abuse might be given an opportunity to be more closely followed. This study was based upon individuals who were referred for further treatment of chronic pain. All individuals were screened and then put through a structured opioid program. The purpose of this opioid renewal clinic was to determine whether a structured approach to opioid prescribing with careful monitoring, even in individuals with known risks for opioid and other substance abuse or frank substance abuse, would allow for a greater percentage of people using the medication properly. In essence, this was a second chance for individuals to be able to benefit from opioid analgesics if that was an appropriate treatment regimen for them. Thirty-eight percent of the people who were referred to this clinic left the practice, so that tells you something about the population. With a structured approach and regular, careful monitoring in this primary care setting staffed by a nurse practitioner and clinical pharmacist, 45% of these problematic patients did quite well. Thirteen percent were sent for addiction medical attention, so that is an important number. Approximately 4% of patients routinely had negative urine drug screens, which was an unexpected response, and they were tapered off of their opioids.
The clinical example that I gave you, and this study that was published in Pain Medicine, both point to the fact that it may be worthwhile in the right setting -- with increasing structure and maybe altering the regimen -- to give individuals who may show signs of opioid abuse or misuse a second chance to determine whether this form of pharmacotherapy can be helpful. Even under the best circumstances, a substantial number of people may not be appropriate candidates, but a significant number of people may do very well given a structured approach. It is an opportunity to individualize treatment for the people we take care of with chronic pain.
I hope this has been helpful and enjoyable. I am Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center. Have a good day.
Opioid Renewal Clinics
This brought to mind the work that was published in 2007 on the development of an opioid renewal clinic. This was a model that was staffed by a nurse practitioner and a clinical pharmacist, and it was designed to aid opioid prescribers in the primary setting so that individuals who had demonstrated signs of substance abuse might be given an opportunity to be more closely followed. This study was based upon individuals who were referred for further treatment of chronic pain. All individuals were screened and then put through a structured opioid program. The purpose of this opioid renewal clinic was to determine whether a structured approach to opioid prescribing with careful monitoring, even in individuals with known risks for opioid and other substance abuse or frank substance abuse, would allow for a greater percentage of people using the medication properly. In essence, this was a second chance for individuals to be able to benefit from opioid analgesics if that was an appropriate treatment regimen for them. Thirty-eight percent of the people who were referred to this clinic left the practice, so that tells you something about the population. With a structured approach and regular, careful monitoring in this primary care setting staffed by a nurse practitioner and clinical pharmacist, 45% of these problematic patients did quite well. Thirteen percent were sent for addiction medical attention, so that is an important number. Approximately 4% of patients routinely had negative urine drug screens, which was an unexpected response, and they were tapered off of their opioids.
The clinical example that I gave you, and this study that was published in Pain Medicine, both point to the fact that it may be worthwhile in the right setting -- with increasing structure and maybe altering the regimen -- to give individuals who may show signs of opioid abuse or misuse a second chance to determine whether this form of pharmacotherapy can be helpful. Even under the best circumstances, a substantial number of people may not be appropriate candidates, but a significant number of people may do very well given a structured approach. It is an opportunity to individualize treatment for the people we take care of with chronic pain.
I hope this has been helpful and enjoyable. I am Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center. Have a good day.
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