Opioids are recognized by the World Health Organization as an essential medicine.
"What is the least amount of medication that provides the highest level of function?"
√ Documented Diagnosis
√ MEDD Factor Calculation
√ Opioid Risk Assessment
√ Review of Concurrent Medications and Conditions
√ Functional Goal Setting
√ Functional Monitoring
√ Pain Score Monitoring
√ Documented Optimization of Non-Opioid Therapies
√ Assessment of Side Effects and Aberrant Behaviors
√ At Least Quarterly Visits
√ At Least Quarterly PDMP Review
√ Patient Education About Opioid Risk
√ Patient Education About Access to Non-Opioid and Non-Medication Treatments for Chronic Pain
√ At Least Yearly Urine Drug Testing Order and Review
√ At Least Yearly Medication Weaning Attempts
√ Naloxone Prescription Consideration
√ Other Clinical Monitoring as Needed
(e.g. for methadone, risk assessment for QT prolongation and consideration of ECG)
"I have chronic back pain and have to see my doctor every month to get a new opioid prescription."
primary care providers
"A lot of my patients have pain, but with only 8 minutes, I don’t have time or tools to be compliant with guidelines. I just have to refer them all to pain specialists."
"We are getting overwhelmed by referrals for patients that need prescriptions. There's no way I can see them all."
"We are experiencing skyrocketing costs and nowhere near enough capacity to address the burden of compliance and take care of all of these patients."
"We have been trying to restrict opioid prescriptions, but it has only resulted in exploding our short and long term costs."
There are no refills on the most commonly prescribed opioids. Patients have to make more frequent trips to the physician's office.
PCP's are overwhelmed writing over 50% of all opioid Rx’s and are “wholesale” referring of patients to pain specialists. There is fear around the "Triple Threat" of malpractice, civil and criminal prosecution.
Pain Specialists don’t have the capacity and are rejecting ~75% of referrals, many patients are left without treatment.
Each opioid Rx can take 30 to 90 minutes or more of additional resources interacting with pharmacies and payers.
Outpatient and ED annual costs are ~$40K for each severe pain patient. Yearly costs exceed treatments of cancer, heart disease, and diabetes.
"...with all these new guidelines, I don't have the time or the tools
to be compliant and safely prescribe opioids."