Follow the Opioid Agreement

By: Dr. Thomas M. Basch

Dear Patients:

If you’ve not read my blog on the difficulties that opioid/narcotic treatment can pose, you might want to read that before this. It’ll put today’s blog into perspective.

As I wrote last time, opioid/narcotic medication is an integral part of pain management. While many patients do not require them in order to obtain the best outcome in terms of relief and quality of life, many patients do. It is that simple. In my humble opinion, a pain specialist who will not prescribe opioids in his/her practice is leaving that difficult work to someone else.

In my last blog, I pointed out that prescribing opioid/narcotic medications is becoming more difficult and frankly more frightening. As is often the case in these situations, it is tempting to find reasons to justify NOT prescribing, quoting literature that states that “there are no long-term benefits to the long-term prescribing of narcotics/opioids to treat non-cancer pain”. Read these studies yourself, and you’ll see that the measurements used to assess the pain-relieving benefits of these medications have been selected to support removing them from the treatment armamentarium.

So, how do we, doctor and patient as a team, safely use opioid/narcotic analgesics, and demonstrate to outsiders, including the skeptical physicians who refer to prescription pain medication as slow poison no safer than arsenic, that Michigan Pain Consultants is not part of the “opioid epidemic”?

FOLLOW THE OPIOID AGREEMENT. Start to finish, to the letter, all the time.

It is that straightforward. You see, we’ve had our opioid agreement reviewed by outside experts and agencies. We’ve discussed it in detail with dispensing pharmacists, psychologists, and addiction specialists. It is a tight, well-built, effective piece of work. But, it must be followed in its entirety. Its strength is in how each component props up the others, in how one instruction plays into the next.

I’ll admit, in the past, I have not followed the agreement as well as I should have. I gave patients not only second, but third and fourth chances to comply. I overlooked small transgressions and violations if the patient seemed to be “mostly” compliant. My intentions were good ones, but in the end, the only thing I really did was put off the difficult decision to discontinue prescribing these medications to a patient who was unable to control his/her use of them. Which, by the way, does not mean that these folks were bad people. Far from it. But, they simply could not follow the rules when it came to this particular medical treatment, at least not when I was treating them. If we were dealing with blood pressure medications or anticoagulants that are far more dangerous than pain pills, no one would have batted an eye. “So the patient couldn’t comply. So what? It happens”. Oh, how I wish that the same grace and understanding could be offered in the case of opioids/narcotics!

Long story short, I’ve had to change, as have my partners. We can no longer offer patients who find themselves falling out of compliance more than ONE (1) chance to correct the course. This is not easy for us to do, and so we shall, as a practice, hold one another accountable. We must. No doctor will be excused from full compliance with the opioid agreement. There is no choice anymore.

If we, as the specialists who are supposed to be the experts when it comes to opioids/narcotics, fail in this, we will be failing our patients. Worse yet, we will be adding fuel to the anti-pain medication fire that threatens to burn all of us.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.