opioid treatment programs

Establishing the Need for Opioid Treatment Programs

Opioid Treatment Programs: Establishing the Need, Benefits, Risks, Screening Tools

Establishing Chronic Pain for Opioid Treatment Programs

  1. Nociceptive Pain
  2. Neuropathic Pain

Establishing Cancer Pain for Opioid Treatment Programs

  1. Nociceptive pain
  2. 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.

Opioid Treatment Programs

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

  • Benefits: Satisfactory pain relief with opioids.
  • Able to maintain independent life style.
  • Risks: Opioid side effects
  • Complications - withdrawal symptoms, overmedications and fatality.
  • Addiction.
  • Diversion.

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 apnoea
  • Respiratory depression

Adverse Effects of Opioid Treatment Programs

  • Constipation
  • Nausea
  • Vomiting
  • Sedation
  • Withdrawal symptoms

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

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: August 21, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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