Opioid-Table 1 Flashcards
What are some reasons providers under prescribe pain meds?
Fear of adverse effects; fear of addiction
What are some reasons providers overprescribe pain meds?
Failure to select proper medication or dose; frustration with poor therapeutic response
What is “misuse” of opioids?
Aka non medical use; use of opioid that departs from intended prescribing
What is opioid “abuse”?
Maladaptive pattern of opioid use with the intent of achieving euphoria or “getting high”.
Is opioid addiction considered a disease?
Yes!! It’s considered a chronic disease
What is opioid “addiction”?
Impaired control over drug use, compulsive drug use, continued use despite harm, drug craving.
What is physical dependence?
Expected response to chronic administration of many drug classes (opioids, anabolic steroids, beta-blockers) resulting in drug class-specific withdrawal syndrome with cessation (rapid dose reduction, declining blood concentration, administration of antagonist)
What is tolerance?
Adaptation from exposure over time which leads to diminished drug effect
What is pseudoaddiction
Iatrogenic behavior which mimics opioid use disorder, but is driven by intense need for pain relief.
What are some of the causes of pseudoaddiction? What should you do if you think your patient has this?
Incorrect dose, pharmacogenetics, worsening pain. You should re-evaluate the patient and YOUR prescribing tactics!
What are some suggestive behaviors of an emerging opioid use disorder?
Selling meds; forgery or alteration of a RX; injecting PO meds; obtaining from non-medical source; resisting therapeutic change despite worsening function or side effects; ETHO abuse; use of illegal drugs; prescription loss or theft; doctor shopping in violation of tx agreement.
What are some of the MOST COMMON suggestive behaviors of an emerging opioid use, according to Dr. D?
Dose escalation (condition may be worsening OR they may be diverting their meds); requesting early refills
What are some behaviors associated with opioid MISUSE?
Aggressive demands for meds; requesting specific med; stockpiling med; tx other sxs with opioids; reluctance to reduce dosing once stable; dose escalation ; obtaining meds from non-medical source; sharing/borrowing meds
What would your ddx be for opioid misuse?
Inadequate pain management (so provider error); inability to comply with treatment; self-medication of mood, anxiety, sleep, PTSD; diversion
What is the most common cause of chronic pain?
Back pain
What are the top 4 analgesics causing emergency admissions for misuse or abuse?
Oxycodone, hydrocodone, methadone, morphine
What are some mortality risk factors associated with opioids?
Prescriber error; non-adherence to treatment regimens; medical and mental heath comorbidities; admini of other CNS depressants (ETOH, benzos, antidepressents etc.); sleep apnea; BMI > 30.
What must you do before prescribing opioids?
Assess opioid benefit and risk of misuse!! Can use Opioid Risk Tool (ORT), SOAPP-R, CAGE and CAGE-AID.
What are some indicators of low risk patients?
Definable pathology with objective s/sxs; clinical correlation with diagnostic testing; with or without psych comorbidity; none or well defined controlled personal or FHx of alcoholism/substance abuse; >45; high motivation; high motivation to function at normal levels
What are some indicators of medium risk patients?
Significant pain with objective s/sxs; moderate psych problems well controlled; moderate well controlled medical comorbidities (like sleep apnea); mild tolerance but no hyperalgesia w/o physical dependence or addiction; past of Fhx of alcoholism/substance abuse; pain involving >3 regions; motivation to function at normal levels
What are some indicators of high risk patients?
Widespread pain without objective s/sxs; pain involving >3 regions of body; aberrant drug-related behavior; hx of misuse, abuse, addiction, diversion, dependency, tolerance and hyperalgesia; hx of ETOHism; major psych disorders;
What are the 5 As?
Analgesic, ADLs, adverse effects, aberrant drug-related behaviors, affect (mood)
Name some elements of a SAFE opioid tx plan.
Dx with appropriate ddx; psych assessment; informed consent; tx agreement; pre and post treatment assessment of pain and level of function; appropriate trial of opioid therapy (=90 days) with possible adjunct med/therapy; regularly assess the 5 As; patient education; documentation; compliance with federal and state laws
How often should you review/monitor low risk patients?
UDS every 1-2 years; PMP 2x yearly
How often should you review/monitor medium risk patients?
UDS every 6-12 months; PMP 3x yearly
How often should you review/monitor high risk patients?
UDS every 3-6 months; PMP 4x yearly
What is the NUMBER 1 question you should ask as a provider?
Is the person able to function in a way that is BETTER than without meds? If yes, then suggests the pain meds are contributing to patient’s wellness.
What are some reasons to terminated opioids or therapeutic relationship?
Opioid no longer effective; opiods no longer stabilize or improve function; patient loses control over use of opioid; diversion; co-morobid use of ETOH, benzos and other CNS depressants; adverse effects are unmanageable
In NM what must the provider do before prescribing any opioids?
Must use assessment tools and consider integrative pain management approaches; review the course of tx at least q6 months; before prescribing any schedule II, III, or IV obtain/review PMP for prior 12 months (if pt is new). Review at least 2x/year for all patients
What are some reasons providers under prescribe pain meds?
Fear of adverse effects; fear of addiction
What are some reasons providers overprescribe pain meds?
Failure to select proper medication or dose; frustration with poor therapeutic response
What is “misuse” of opioids?
Aka non medical use; use of opioid that departs from intended prescribing
What is opioid “abuse”?
Maladaptive pattern of opioid use with the intent of achieving euphoria or “getting high”.
Is opioid addiction considered a disease?
Yes!! It’s considered a chronic disease
