scholarly journals Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings

2015 ◽  
Vol 37 (1) ◽  
pp. 154-160 ◽  
Author(s):  
Rachel Ceasar ◽  
Jamie Chang ◽  
Kara Zamora ◽  
Emily Hurstak ◽  
Margot Kushel ◽  
...  
Keyword(s):  
Primary Care Providers ◽  
Safety Net ◽  
Prescription Opioid ◽  
Care Providers ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Urine Toxicology ◽  
Prescription Opioid Misuse ◽  
Noncancer Pain ◽  
Pain Patients

Opioid Misuse and Addiction Among Patients With Chronic Pain

2019 ◽  
pp. 339-354
Author(s):  
Marc O. Martel ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Medication Misuse ◽  
Opioid Medications ◽  
Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

Decline in primary care providers’ prescribing of Schedule II opioids following the implementation of federal and state guidelines

2019 ◽  
Vol 15 (2) ◽  
pp. 111-118 ◽  
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
James P. Murphy, MD ◽  
Douglas J. Lorenz, PhD ◽  
Alisha Bell, MSN, RN, CPN ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Care Practice ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Prescription Opioid Misuse ◽  
Morphine Equivalent

Objective: Prescription opioid misuse represents a social and economic dilemma in the United States. The authors evaluated primary care providers’ (PCPs) prescribing of Schedule II opioids at our institution in Kentucky.Design: Prospective evaluation of PCPs’ prescribing practices over a 3-year period (October 1, 2014 to September 30, 2017) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards. Special attention focused on Schedule II opioid prescriptions with a quantity 90, Opana/ Oxycontin, and morphine equivalent daily dosage.Results: A statistically significant increase in the total number of PCPs and PCPs who prescribed Schedule II opioids was observed, while there was a concurrent significant decrease in the average number of Schedule II opioid pills prescribed per PCP, Schedule II opioid prescriptions per PCP, Schedule II opioid pills prescribed per patient by PCPs, Schedule II opioid prescriptions with a quantity 90 per PCP, and Opana/Oxycontin prescriptions per PCP. A statistically significant decline in the average morphine equivalent daily dosage of Schedule II opioids per PCP was noted.Conclusions: This study reports the benefit of incorporating federal and state regulations and institutional evidence-based guidelines into primary care practice to decrease the number of Schedule II opioids prescribed. Further preventive measures include selecting alternative treatments to opioids and reducing the rates of opioid nonmedical use and overdose while maintaining access to prescription opioids when indicated.

scholarly journals Women on the Edge

2017 ◽  
Vol 44 (4) ◽  
pp. 301-320 ◽  
Author(s):  
Kelly R. Knight
Keyword(s):  
Drug Use ◽  
White Women ◽  
Premature Death ◽  
Primary Care Providers ◽  
Opioid Epidemic ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Race And Class ◽  
Social Anxieties ◽  
Noncancer Pain

The current “opioid epidemic” provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the “opioid epidemic.” Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that “every 25 minutes a baby is born suffering from opioid withdrawal,” leading to costly hospital stays for infants and the potential for mother–child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.

Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity

2019 ◽  
pp. 1-18 ◽  
Author(s):  
Caleb J. Reynolds ◽  
Noel Vest ◽  
Sarah L. Tragesser
Keyword(s):  
Chronic Pain ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Prescription Opioid Misuse ◽  
Pain Patients

Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk—an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features—especially unstable identity and self-harmful impulsivity—play a unique role in problematic prescription opioid use in chronic pain settings.

Do pain specialists meet the needs of the referring physician? A survey of primary care providers

2018 ◽  
Vol 4 (1) ◽  
pp. 13 ◽  
Author(s):  
Jane R. Wilkens, MD ◽  
Miles J. Belgrade, MD
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Primary Care Providers ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Psychological Issues ◽  
Pain Specialist ◽  
Noncancer Pain

Objective: To study the factors that influence the use of opioids in the management of chronic noncancer pain (CNCP) by primary care providers (PCPs) for patients returning from a pain specialist.Design: A survey of PCPs.Setting: Two physician groups in the Minneapolis-St. Paul metropolitan area.Participants: Two seventy-six PCPs surveyed and 80 surveys returned. Main outcome measures: Participants rated the importance of specific concerns regarding the role of pain specialists and the use of opioids in the management of CNCP. Past experience with pain specialists, comfort using opioids, and opinions regarding a trilateral opioid agreement were also examined.Results: The top concerns for PCPs were as follows: the use of opioids in patients with chemical dependency or psychological issues, the escalation of opioid dosing, and the use of opioids in pain states without objective findings. They also ranked highly the importance of coordinating the return of patients from a pain specialist with explicit opioid instructions and the availability of consultation by phone or a timely follow-up visit. PCPs were supportive of the concept of a trilateral opioid agreement.Conclusions: PCPs have significant concerns regarding the prescribing of opioids in CNCP. They desire closer collaboration with pain specialists, including more explicit plans of care when patients are transferred back to them. The trilateral agreement may provide one framework for better collaboration.

Factors associated with participation and nonparticipation in a VA Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

2020 ◽  
Vol 16 (3) ◽  
pp. 179-188
Author(s):  
Amber Martinson, PhD ◽  
Amanda Kutz, PhD ◽  
William Marchand, MD ◽  
Julie Carney, RN ◽  
Jamie Clinton-Lont, MS, CNP
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pain Education ◽  
Chronic Noncancer Pain ◽  
Medical Diagnoses ◽  
Noncancer Pain

Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we compared demographic and health characteristics between participants and nonparticipants drawn from the same defined population.Design/Methods: Retrospective chart review comparing participants and nonparticipants in terms of two categories of variables: (1) demographic characteristics and (2) physical/mental health characteristics.Setting: VA Primary Care.Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy 3 months being managed in primary care.Results: A total of 749 veterans (424 participants in PC-POP and 325 nonparticipants) were included in the final analysis. Results showed that nonparticipation was associated with more widespread musculoskeletal pain, low back pain, anxiety, higher mortality, and rural areas. Participation was associated with more medical diagnoses overall, hypertension, sleep apnea, fibromyalgia, peripheral nerve pain, depression, and female gender. Other demographic and physical/mental health variables did not significantly differ between the groups.Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, programs are needed to assist primary care providers to meet the rigorous requirements of guideline concordant care. The current study examined participation factors in such a program and found that certain veterans were less likely to participate than others. Identifying such veterans at the outset, in combination with intentional recruitment efforts and individualized interventions, may promote entry into PC-POP.

Chronic opioid therapy issues associated with opioid abuse potential

2018 ◽  
Vol 5 (5) ◽  
pp. 287 ◽  
Author(s):  
Howard S. Smith, MD ◽  
Kenneth L. Kirsh, PhD ◽  
Steven D. Passik, PhD
Keyword(s):  
Primary Care Providers ◽  
The United States ◽  
Opioid Therapy ◽  
Due Diligence ◽  
Care Providers ◽  
Chronic Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Potential Risk Factors ◽  
Noncancer Pain ◽  
Documentation Tool

Chronic opioid therapy continues to be an important “mainstream” option for the relief of pain, despite continued debate over the efficacy and safety of utilizing opioids with chronic noncancer populations. With this increase in utilization for medical purposes, the authors have also experienced a troubling rise in the abuse and diversion of prescription opioids. Providers should note this relationship and always perform due diligence when assessing whether a patient with chronic noncancer pain is an appropriate candidate for opioid therapy based on potential risk factors. Because of the relative shortage of board-certified pain practitioners in the United States, much of the practice of pain management falls on primary care providers, who might feel uncomfortable or overwhelmed when facing these issues. To this end, a set of guidelines are discussed to promote an approach to chronic noncancer pain utilizing “universal precautions” principles. In addition, several risk tools are evaluated, including the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), the Opioid Risk Tool (ORT), and the Pain Assessment and Documentation Tool (PADT). Finally, discussion is presented regarding what practices seen in opioid prescribing can be considered “in-or-out” of the mainstream box.

scholarly journals Knowledge, Attitudes and Beliefs about Chronic Noncancer Pain in Primary Care: a Canadian Survey of Physicians and Pharmacists

2014 ◽  
Vol 19 (5) ◽  
pp. 241-250 ◽  
Author(s):  
Lyne Lalonde ◽  
Vincent Leroux-Lapointe ◽  
Manon Choinière ◽  
Elisabeth Martin ◽  
David Lussier ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Initial Assessment ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Definition Of ◽  
Noncancer Pain

BACKGROUND: Primary care providers’ knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management.OBJECTIVES: To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP).METHOD: Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowPain-50 questionnaire. Pharmacists completed a modified version. A multivariate linear regression model was developed to identify the determinants of their KAB.RESULTS: A total of 137 of 387 (35.4%) physicians and 110 of 278 (39.5%) pharmacists completed the survey. Compared with the physicians, the pharmacists surveyed included more women (64% versus 38%) and had less clinical experience (15 years versus 26 years). The mean KnowPain-50 score was 69.3% (95% CI 68.0% to 70.5%) for physicians and 63.8% (95% CI 62.5% to 65.1%) for pharmacists. Low scores were observed on all aspects of pain management: initial assessment (physicians, 68.3%; pharmacists, 65.4%); definition of treatment goals and expectations (76.1%; 61.6%); development of a treatment plan (66.4%; 59.0%); and reassessment and management of longitudinal care (64.3%; 53.1%). Ten hours of reported CEP sessions increased the KAB score by 0.3 points. All clinicians considered a CEP for CNCP to be essential. Physicians preferred an interactive format, while pharmacists had no clear preferences.CONCLUSION: A CEP to improve primary care providers’ knowledge and competency in managing CNCP, and to reduce false beliefs and inappropriate attitudes regarding CNCP is relevant and perceived as necessary by clinicians.

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