Jennifer Bolen: Most state licensing boards specify that if you’re in a chronic opioid prescribing situation, you have to do a history and physical evaluation, write up a treatment plan, be sure there is informed consent, and a treatment agreement. If it’s a new patient that you don’t know well, think about a slow dance. Take some time. Get the old medical records. Do a PDMP check – the prescription drug monitoring database or program. Get that information and you’ll cut down on the potential for hit and run where a patient is coming in just to get a prescription. It can also set the stage for a very good relationship where the physician can trust but verify the patient’s situation.
Kevin Barnard: I don’t think it’s out of the scope of good practice to even have a conversation pre-prescription of opioids to say, I’m considering prescribing these things to you, but just keep in mind that these can cause problems with people and you really don’t know whether it will or won’t unless you do it or you take these medications. But these are things that you should be aware of that could go wrong and if something is going wrong, I need to know about it as the prescriber.
Stephen Ziegler: The foundation of the patient–provider relationship is one of mutual respect and trust and to help ensure that trust and to address any road bumps that might come along the way, it’s important to have that open dialogue so that a patient can feel comfortable about discussing sensitive matters and vice-versa. And as a frontline provider, don’t be hesitant to seek out additional resources to help guide the process.
Kevin Barnard: I think a lot of prescribers are hesitant to ask the question because they really don’t know what to do next – what if the patient says yes, what am I going to do now? So build the infrastructure for referral, understand what’s available in your community so you can readily refer this person at least to AA, to a 12-step meeting or an addiction specialist or somebody who is equipped to really handle the situation.