Establishing the Need for Opioid Treatment Programs
Establishing Chronic Pain for Opioid Treatment Programs
- Nociceptive Pain
- Neuropathic Pain
Establishing Cancer Pain for Opioid Treatment Programs
- Nociceptive pain
- Neuropathic pain
Establishing Chronic Pain for Opioid Treatment Programs
- History and physical examination
- Check all investigations
- Second opinion- neurologist, neurosurgeon, orthopedic surgeon, Rehab Physical medicine specialist and Psychiatrist.
- Consider history of previous drug abuse- alcohol, cocaine, heroine, sedatives, stimulants
- Detail history of present addiction
Pre-Existing Conditions for Opioid Treatment Programs
- History of drug abuse- avoid opioids, if risk benefit suggest opioid treatment is advised physician will consider close monitoring, involve addictionologist and psychiatrist in ongoing treatment plan.
- Family history of drug abuse- physician will consider detail discussion of risk and benefits, close monitoring and family conference with close family members.
- Personality disorder- psychiatrist opinion and risk/benefit consideration
- Psychiatric disorder- psychiatrist opinion and risk/benefit consideration
- Medications- if prescribed for other diseases then drug interaction and side effects will be considered, consultation with pharmacist will be considered.
Consider Opioid Medications Only If:
- Non-opioid Medications- failed or severe side effects contraindicated medications.
- Physical therapy – failed or not indicated.
- Interventional pain therapy- failed or not indicated.
- Surgery- failed or not indicated.
Benefits and Risks of Opioid Treatment Programs
Schedule Treatment for Opioids
- Trial of opioid therapy.
- Titration of dose- start low dose, titrate slow.
- Short acting and long acting medications.
- Short acting opioid- safer.
- Long acting opioids: Lower risk of addiction.
- Round the clock dosage necessary to prevent withdrawal symptoms and achieve optimum pain relief.
- Overdosage of long acting opioid if taken additional pills for breakthrough pain.
- Breakthrough pain may need to be treated with short acting opioids.
- Previous opioid treatment- failed or inadequate pain relief, may need higher dosage to begin opioid therapy.
- Resistance- patient may have higher resistance and need higher dosage.
- Tolerance- patient may have developed tolerance and need higher dosage.
Diagnostic Tests for Opioid Treatment Programs
- Establish diagnosis X-Ray, CAT scan, MRI, EMG, Blood Examination or any other test.
- Establish urine drug test.
- MAPS.
Assessment of Risk for Opioid Treatment Programs
- Drug abuse- alcohol, cocaine, heroine, sedatives, stimulants.
- Addiction
- Misuse
- Diversion
- Psychosocial factor
- Family history
Risk of Opioid Prescription:
- Drug abuse
- Addiction
- Misuse
- Diversion
- Overdose
- Sexual dysfunction
- Sleep apnea
- Respiratory depression
Adverse Effects of Opioid Treatment Programs
Opioid Screening Tools
- Follow up history
- Same pharmacy
- Pill counts
- Family discussion MAPS
- Urine drug test
- No refill or one refill
Informed Consent
- Potential risk
- Alternatives
- Policies
- Goal
- Expectation
