In this week's episode of the Spine & Nerve podcast Dr. Brian Joves and Dr. Nicolas Karvelas are talking opiates again. They discuss the steps to take to ensure we are doing what we can to optimize the safety of not only the patient but also the healthcare provider when dealing with opioid medications.  

In situations where chronic opioid use is indicated, there are certain steps that can be taken to optimize safety for all involved.  Some key points to take away from today's discussion include:

-Review CURES (Prescription Drug Monitoring Program) data before any Rx of opioids

-Obtain baseline UDS, and monitor at least annual random UDS moving forward; and most importantly interpret and utilize the results in treatment decisions

-Perform screening tools for risk of aberrancy, and significant psychiatric comorbidities (ORT, PHQ-9, GAD-7) prior to prescribing and then repeat at appropriate intervals

-Work to find lowest effective dose, with goal of less than 50 OME as a general guideline

-Thoroughly evaluate benefits and harms of continued therapy with patients every 3 months or more frequently (including evaluation of not just improvement in pain score, but also functional improvement)

4 A’s

-Minimize/avoid use of centrally active sedative medications in patients on opioid medications, especially in regards to Benzodiazepine meds

-Rx of Naloxone and provision of education regarding administration of Naloxone for any patient on 90 OME, or for any patient concurrently Rx’d a Benzodiazepine and an opioid medication, or for patient at high risk (hx of overdose, or hx of substance use disorder) (as per California law: AB 2760)

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This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.