It’s important to start at the beginning and screen patients for indicators that could be suggestive of abuse, misuse, diversion, and unintentional use. We can use actual validated instruments to screen for patients who may have some issues with misuse and abuse and diversion. It is an important tool to use the opioid agreements, I think, to line out the rules of play. Also, to do random urine screen is important, too, and to just have an open upfront dialogue and to form trusting relationships with patients. I think probably the Number One step is forming a trusting relationship, offering hope to the chronic pain patient but clearly delineating that these are the rules of play. Patient-prescriber agreements are important, but I think we have to be careful how we use them. Patients can often feel like that is a punitive effort. I don’t like the word ‘contract.’ Contract sounds like if you violate the contract we’re going to take you out back and beat you up a little bit. But an ‘agreement’ just establishes the rules of play. This is what I will do for you, this is what you will bring to the arrangement, and this spells out what our relationship will be.
I spend a lot of time educating my patients about the appropriate storage of their medications. I tell them you store your medicine like your money. You don’t keep your money on the kitchen table. You don’t leave your medicine on the kitchen table. Look at unintentional death from opioids; it’s mostly where people have obtained these products from a family member or a friend. If you store them appropriately, that’s certainly a good step forward.
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