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Dr. McPherson comments on recent consensus guidelines for methadone prescribing, with background on the properties of this analgesic that render it both an attractive and challenging opioid for pain clinicians. Special considerations for patients with advanced illness are also discussed.
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We know more now about the risk factors and patients who may be good candidates for naloxone. These would include patients on higher doses of opioids, patients with complicated comorbidities like renal or hepatic disease, sleep apnea, and most obviously, those with active substance abuse, or a...
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Primary care practitioners need to be aware of some changes relating to the use of opioids to treat pain. State-licensing board guidelines are changing. There’s some new and good legislation regarding the use of naloxone kits to help people who might be at risk for opioid overdose or even...
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Patient screening and risk management in opioid therapy is really quite a challenge and requires significant knowledge of the medications particularly with high-dose opioids. First of all, you have to make a decision of whether or not, as the dose escalates, the patient should even be on opioids...
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Effective use of naloxone for opioid overdose requires, first, the ability to recognize the symptoms and signs of opioid induced respiratory depression. All healthcare providers, responders, and patients need education in identifying overdose emergencies. Stakeholders also need to keep abreast of...
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A clinical professor of pharmacy offers some insights for primary care on best practice in opioid prescribing. Dr. Atayee discusses the importance of risk assessment, competence in dosing and titration, and alternate routes of administration, especially in the palliative care setting.
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A panel of legal and compliance experts discuss some of the issues confronting prescribers of controlled substances in the management of patients who may be abusing and/or diverting their medications. How should clinicians negotiate the terrain between confronting suspicious patient behavior and...
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It turns out that psychological factors strongly correlate with prescription for opioids and also for opioid dose. Some of those factors are depression, anxiety, post-traumatic stress disorder, and history of substance use disorder. So a person’s history and also their current psychological make-up...
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Avoiding Risks while Preserving Benefits
The current approach to managing pain in a postoperative environment has continued to progress even over the last decade in terms of multimodal analgesia. So after a patient leaves the hospital, after they finish their surgery and had this intensive...
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Constipation happens universally in patients who are prescribed opioids. I’ve met a handful of patients over the years that don’t develop constipation from opioids and I always think the same thing. You’re not taking your drug. That’s how universal constipation is associated with opioids. Just as we...