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  • Golden Rules Not to Break

    As you have already learned opioid medications can improve ones quality of life but these medications are highly addictive and when used improperly can lead to serious consequences such as death. There there are a few GOLDEN RULES that most pain clinics and physicians will expect you to adhere to. Please discuss with your particular physician or pain clinic as to their strict office policies. You should always read fully the treatment agreement provided to you by your clinic. Failure to comply with your treatment agreement will place you at increased risk of adverse events with the use of opioid therapy, such as overdose and death and may subject you to discontinuation of opioid therapy as an option in your treatment plan. DO NOT VIOLATE THE FOLLOWING GOLDEN RULES No Early Refills: NEVER TAKE MORE THAN PERSCRIBED. Always Follow the directions given to you by your provider regarding your medications and that written on your prescription bottle. Discuss with your provider what your options are to treat a pain flare, as overtaking your medication due to pain flare may not be considered a valid excuse. You may be subject to Random Pill Counts by your provider to ensure you are not taking more than prescribed. Cures: Your provider may check the DEA database regularly which lists all opioid medications prescribed. Your treatment agreement will usually state that you can not fill outpatient opioid medications from other outside providers, such as dentist emergency room, surgeons, ETC. Urine Drug Screening: Your provider may check urine drug screens to make sure you are ONLY taking the opioid medications prescribed to you. Never take a friend's medication. Never take old medication even if it was prescribed to you in the past unless instructed by your provider. If you are prescribed an opioid medication that does not show up in a UDS you may be required to provide an explanation. It could be considered a violation without a reasonable explanation for the non-presence of a prescribed medication. 30-Day Refill Policy: You typically are provided a prescription that is to be used over a 30-day period. This may vary from clinic as some clinics write only 28-day supplies, so be aware of how long the prescription you are given is expected to last. If for example you are given a 30-day supply of medications within 28 or 29 days. Due to pharmacy issues and other factors patients may pick up their next prescription on day 28 or 29. If so the expectation is that you Do Not Open The Next Prescription Bottle Until Due ("Day 31"). You are responsible for keeping track of when your next prescription is due and when your next bottle can be opened. Failure to comply and keep track of when you can start your next prescription bottle may be considered a violation your treatment agreement. You may be required by your provider to bring your prescription bottles to each visit to ensure compliance.

  • Pain Relief vs. Function/ADL

    Your doctor may often ask about changes in your function along with changes in your pain scores throughout your treatment. They may ask you questions in regards to your activities of daily living (ADLs). Activities of daily living is a term used in healthcare to refer to daily self-care activities within an individual's place of residence and/or their outdoor environments. Often patients may report no improvement in pain scores, but when questioned further they will show a significant improvement in function due to the treatments they received. As a patient it is important to evaluate yourself for improvement in function and not just improvement in pain. Increase function can be a goal to focus on when deciding on treatment options to improve your overall quality of life. Having goals relating to increase in function can create more structure to one’s management and justification for use of medications and treatments. Goals that you set should be simple and reasonable, such as being able to complete a favorite hike, being able to take one’s grandchildren fishing, etc.

  • Welcome

    Opioid therapy – when used safely – can be a very important part of a patient’s treatment plan for chronic non-terminal pain. That being said, opioid medications and medications similar to opioids in the wrong hands and when misused can have deadly consequences. The lack of knowledge about these medications and their appropriate use has often led to a deadly outcome. When used appropriately, they can often help restore one’s quality of life and function. Therefore, knowledge is power; this course was designed to educate not only our patients, but the community and referring physicians alike on the facts and opinions behind opioid therapy. The following course will cover a wide range of issues surrounding these medications. It is important that you complete the course fully. There is an optional section after the course that we recommended you read as well. In order to establish that you have understood the information, you will be given a set of questions to answer. Upon completion of the course you will also be given a printable “Certification of Completion.” We recommend you provide a copy of this certification to your primary care physician and the physician prescribing your medications so they may scan it into your medical records. The benefit to patients who use these drugs correctly is tremendous. Therefore, it is vital that we understand and develop better and safer practices to protect both our patients and the community from the misuse of these medications, or they will no longer be available in the future.

  • Introduction

    Welcome to the online Opioid Safety Course, part of the Online Chronic Pain Education and Prevention Program. Opioid therapy when used safely can be a very important part of a patient’s treatment plan for chronic non-terminal pain. That being said, opioid medications and medications similar to opioids in the wrong hands and when misused can have deadly consequences. Knowledge is power and this course was designed to educate not only patients, but the community and referring physicians alike on the facts and opinions behind opioid therapy. The lack of knowledge about these medications and their appropriate use has often led to a deadly outcome. When used appropriately they can often help restore one's quality of life and function. The following course will cover a wide range of issues surrounding these medications and it is important that you complete it fully. There is an optional section after the course that I recommended you read as well. In order to establish that you have understood the information, you will be given a set of questions to answer. Upon completion of the course, you will also be given a printable “Certification of Completion”. We recommend you provide a copy of this certification to your primary care physician and the physician prescribing your opioid medications.. The benefit to patients who use these drugs correctly can be tremendous. Therefore, it is vital that we understand and develop better and safer practices to protect both the patients and the community from the misuse of these medications or they will no longer be available in the future. As a community let us learn to USE the medications appropriately and not ABUSE them. You will notice a lot of repeated information on this website which was done intentionally to stress the importance of critical information.

  • Introduction

    Opioid therapy is not right for every patient, however, for some, this may be a reasonable option. You should always try non-opioid therapies before considering opioid therapy and understand the benefits, risks, and alternative options before starting opioid therapy. Often our treatment plan will be combined with non-opioid therapies. It is important that you establish treatment goals to improve pain and function. Patients undergoing opioid therapy are usually required to sign a treatment agreement with our provider. It is your responsibility to read your treatment agreement and informed consent before starting opioid therapy. This agreement usually stipulates that you will only receive opioids or other controlled medications from one provider/clinic. Often these will usually be in association with a monthly office visit for therapeutic drug monitor and appropriate medical supervision. You should always follow all office policies in your treatment agreement. Safety monitoring will usually include but is not limited to routine urine drug screening and CURES monitoring. Only use medications as prescribed. You should NEVER take more than prescribed and taking more medications than prescribed increases the risk of significant adverse events such as death. You must lock up all your opioid medications in a safe. “In 2008, nearly 36,500 Americans died from drug poisonings, and of these, nearly 14,800 deaths involved opioid analgesics.” --FDA “Almost 16,000 Americans died of overdose involving opioids in 2009.” -- FDA “In 2009, there were nearly 343,000 emergency department visits involving nonmedical use of opioid analgesics.” --FDA “Based on the 2010 National Survey on Drug Use and Health, public health experts estimate more than 35 million Americans age 12 and older used an opioid analgesic for non-medical use some time in their life—an increase from about 30 million in 2002.” --FDA “In 2011, an estimated 22.9 million prescriptions for extended-release and long-acting opioids were dispensed in the U.S.” -- FDA “80% of the world's pain pills are consumed in the United States.” -- American Society of Interventional Pain Physicians. “The total annual incremental cost of health care due to pain ranges from $560 billion to $635 billion (in 2010 dollars) in the United States, which combines the medical costs of pain care and the economic costs related to disability days and lost wages and productivity. In 2010 there were an estimated 100 million Americans dealing with chronic pain.” – AAPM “Accidental overdoses from prescription drugs now exceed the combined total of deaths from heroin, crack, and methamphetamines. Accidental deaths from overdoses resulting from legal prescription drugs now exceed deaths by car accidents.” – CNN “Every 19 minutes someone dies from a drug overdose in the United States. This number includes those dying from both legal and illegal drugs; however, most are due to legal prescription drugs. ” – Dr. Sanjay Gupta “I just want people to remember: opioid addiction is a deadly disease, it kills people all the time, we are dealing with a fatal illness more likely to kill you than the vast, vast, vast majority of cancers—that’s a fact” – Dr. Drew Pinsky “The medications don’t pull the trigger, but the failure to educate ourselves and our patients about the safe use of these medications is deadly.” – Dr. Yogi

  • Mechanism of Action

    Opioids can be a life changing medication for many patients with chronic pain, if used responsibly. Opioids have great potential to ease pain; however they have equal potential for deadly side effects and misuse as stated before. Opioids mimic the actions of endogenous opioid peptides by interacting with mu, delta or kappa opioid receptors. Opioids work by binding to opioid receptors in the central and peripheral nervous system were they produce analgesic effects by decreasing the perception of pain, decreasing your reaction to pain, and increasing pain tolerance. They do not have an effect on the source of the pain, such as anti-inflammatory medications by reducing inflammation. There are many types of nerve fibers in our body. The two main nerve fibers types that are involved in the perception of pain are known as C-fibers and A-delta fibers. When opioids bind opioid receptors located on these nerve fibers they block the release of pain neurotransmitters (through a complicated process which we do not need to discuss here otherwise you would fall asleep reading it). The blocking of these neurotransmitters, such as glutamate, substance P, and calcitonin gene-related peptide from the nociceptive fibers, results in analgesia (i.e. pain relief). Opioids also bind to other opioid receptors throughout the body, such as gastrointestinal tract, producing unwanted side effects such as constipation, respiratory depression, and sedation. They also often produce euphoria, which is one of the reasons their use can lead to abuse, misuse and addiction

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