(continued from page 11)
P
Plan (establish specific functional goals for periodic review)
L Legitimate working diagnosis established (i.e. objective
evidence)
I Informed consent (written) and treatment agreement
(recommended)
A
Addiction / diversion Screening
N Non-controlled medications tried before going to controlled substances
C Comprehensive history needs to be obtained and docu-
Two prime examples of efforts to educate prescribers are (a) the
OPIOID course sponsored by the Greater Louisville Medical Society and (b) the First Do No Harm Providers’ Guide from Indiana’s
Prescription Drug Abuse Taskforce.
mented.
E Exam of appropriate complexity to establish baselines for
follow-up
When both prescriber and patient understand the risks and watch
for the telltale signs, early intervention can keep you out of trouble,
despite what the Harold Hills of the world might say.
PQRST – That which needs to be ongoing after the ninety-day
In my experience, most people will do the right thing if they
know what the right thing is. President Ronald Reagan’s Cold War
policy with the Soviet Union was to “trust but verify.” When you
give someone a reputation to live up to, they are positively motivated
to deserve that reputation – and deserve that trust. The various
measures prescribers take to verify proper use of pain medications
provide boundaries that can guide and comfort all parties involved.
Beyond the rules, regulations, and guidelines that make up these
boundaries, lies the indisputable truth that physicians have an
obligation to treat suffering. It’s our calling.
mark
Periodic review (after the first month, up to physician’s judgment)
Query KASPER every three months
Refer to specialists and consultants as necessary
Screen annually for general health concerns
Toxicology screens (i.e. urine) and pill counts randomly and at
intervals dependent on the patient’s level of risk
Let’s not forget Indiana. There are regulations in the Hoosier state
as well, but they only apply when a patient is prescribed:
(a) “More than sixty (60) opioid-containing pills a month” for more
than three consecutive months; or
(b) “A morphine equivalent dose of more than fifteen (15) milligrams
per day; for more than three consecutive months.”
When these thresholds are met, Indiana physicians must be:
•
DRAMATIC at the start;
•
Meet FACE-TO-FACE with the patient at least every 4 months;
•
Conduct an INSPECT and DRUG SCREEN annually;
•
REVIEW the plan, REVISE the plan and REFER when the
morphine equivalent dose is greater than 60 mg/day.
At the initial evaluation a Hoosier physician must be DRAMATIC
D Diagnosis