The Opioid Renewal Clinic: A Primary Care, Managed Approach to Opioid Therapy in Chronic Pain Patients at Risk for Substance Abuse

Abstract

An NP/clinical pharmacist-run clinic, supported by a multi-specialty team, can successfully support a primary care practice in managing opioids in complex chronic pain patients.

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

“…11,13 A standardized approach could involve using screening tools to identify patients at increased risk for opioid misuse; 25,47-50 a treatment agreement that stipulates the necessity for regular office visits, restricted early refills, and urine drug testing; 51 and team-based care to track patients' visits, prescriptions, progress, and aberrant drug-taking behaviors. 52 Our research demonstrates the need for proactive approaches to this quality of care issue that has significant public health consequences.…”

Opioids in chronic noncancer pain

“…The central question when prescribing opioids for chronic, noncancer pain is how best to balance the risk of opioid abuse with the pain relief provided by these medications [18][19][20][21][22][23][24][25][26][27]70,71,[111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130]. While proponents claim extremely low levels of opioid abuse [55], opioids are by far the most abused drugs, especially in chronic pain management settings [18][19][20][21][22][23][24][25][26][27][28].…”

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

“…The Philadelphia Veterans Administration created an effective population management program within the clinic for patients with problematic behaviors; they offered provider and patient education, a dedicated team of specialists (a nurse practitioner and a clinical pharmacist), more frequent patient visits, and biweekly review of cases by a multidisciplinary pain team including an addiction psychiatrist and physiatrist. 22 A complementary approach is endorsed by the Centers for Disease Control and Prevention: "clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder." 6 There is ample evidence that medication-assisted treatment is the most effective way to retain these patients in treatment and improve social function.…”