I was reading a recent commentary in the June 2013 issue of Pain Medicine News by the new president of the American Academy of Pain Medicine. In the fairness of disclosure, I must confess that Dr. Lynn R. Webster MD is one my most favorite physicians. I have had the pleasure to meet, collaborate with as well as co-present with him at a national conference. He ranks high in my book as one of the top five pain experts in our nation.
His words to other pain medicine specialists are inspiring and sensible. I urge you to read his recommendations to other clinicians about how to prescribe opioids carefully and safely in order to lessen the risk of unintentional overdose. His eight principles for safer prescribing make sense.
So, if your health care provider recommends an opioid trial or you have been taking opioids for some time now, here is a “patient-friendly” version that you should embrace. After all, you are an important member of your pain care team:
Eight Prescribing Principles: A Guide For Patients
Your Clinician Should:
- Assess you for the risk of taking your pain medication inappropriately (using it for reasons other than pain, taking more than prescribed or with alcohol or other drugs that cause sleepiness) before starting opioid therapy and create an appropriate pain care plan accordingly.
- Watch for and address any mental health disorder that you may have. A referral to mental health specialist may be indicated.
- Use the most current conversion table carefully or consult with a pain trained pharmacist before rotating (switching) from one opioid to another whenever this adjustment is needed.
- Avoid recommending that you take benzodiazepines (Xanax, Valium, Ativan) along with opioids, especially during sleep hours. If this is part of your medication plan, talk about how to limit its use or if you can switch to a different medication (for anxiety, muscle spasms or difficulty sleeping)
- Think differently about methadone. If methadone is to be considered it should not be the first opioid you are started on. When it is started, the lowest possible dose should be the starting dose and increased very slowly, only as it may be required.
- Assess you for sleep apnea if you are taking high daily doses of methadone or other opioids and if you have a family or personal history.
- Remind you (if you have been on long-term opioid therapy) to reduce your opioid dose when you have the common cold, flu or an asthma attack.
- Avoid ordering long-acting opioid formulations for you if you experience acute, postoperative or trauma-related pain.