According to a recent Harvard survey, 1 in 3 Americans blame doctors for the opioid epidemic.
Annals of Internal Medicine, January 2016:
91% of patients experiencing a nonfatal opioid overdose continued to receive prescription opioids and 7% had a repeat overdose
Repeat overdosing was significantly increased with higher-dose opioids or concomitant use of benzodiazepines
70% of patients who continued to receive opioids after the overdose obtained them from a prescriber who had treated them before the overdose
Just ask Gretchen Fordham, she was in a car accident while under the influence, needed to be revived using Narcan. Was taken to the emergency room, treated and released with a prescription for opioids. She died that evening of a drug overdose. And there is a doctor whose name is on the bottle.
Or the athletes in the article Smack Epidemic… one of the best articles written on the epidemic out of Sports Illustrated. June, 2015
Sons, daughters, friends, individuals all striving to be the best. From good families. Beautiful and All American. We hear 2 things: sports injuries and wisdom teeth. Think about our young athletes. Trying to make a name, trying to make it to the big time. They suffer an injury and when they stop taking their prescription, they experience migraines, nausea vomiting and more. They need to perform. And they know that if they take another pill, they will feel better.
But as their parent’s lament following their death from drug overdose, NO ONE TOLD US THEY WERE ADDICTIVE. NO ONE TOLD US.
Tens of thousands of people are dying every single year and despite our best efforts, death and overdose rates continue to skyrocket.
I travel all over the country, talking and consulting with medical and dental practitioners, businesses, communities and more and one thing is without refute….everyone says, “No one told us they were addictive.” WHO IS THE NO ONE?
DOCS, DENTISTS, NPS/PAS…. YOU ARE THE NO ONE.
So criminal cases against practitioners abound but even more devastating is the civil litigation case! Millions of dollars in jury verdicts and settlements for the plaintiff as a result of failing to inform and monitor your patients for signs of continued disease state. SUD, OUD, Addiction, Abuse…. Whatever you want to call it.
If you remember nothing else, remember these 3 things: INFORM, MONITOR AND DOCUMENT!
Through my companies, The Stutman Switalski Group, Switalski Consulting and my firm, Lippitt O’Keefe Gornbein in Michigan, I have crafted the best informed consent document based on all of the best evidence, guidelines, practical applications, caselaw, standards of care and more. In its first 6 months of use by practices all over the country, the reviews following implementation are beyond expectations.
So practitioners, remember, I am on your team. The judge, the prosecutor, the litigator with the medical background. I believe that despite all of the adversity – the patient satisfaction surveys, pain as the 5th vital sign, marketing – Cialis – why are those people in separate tubs? MECRA, MIPPS reimbursements…
I believe we can all be the change.
Plenty of blame to go around – let’s focus on solutions.
- Patient History
- Use screening tools risk stratification
Decision to use controlled substances --- OPIOIDS, BENZOS AND STIMULANTS
- Statement of purpose/goals
- Risk, benefits, alternatives, right to refuse
- Treatment plan
- Referrals- care coordination strategies YOU ARE TREATING A DISEASE
- Cures for abandonment
Throw out your one page documents – it’s not informing anyone of anything!
More to know but this is a good start.
Then monitor your patients – because there is a place for opioids and benzos!
KEY IS TO PREVENT HARM!
DO NO HARM!!
ENSURE COMPLAINCE AND SUCCESS WITH THE TREATMENT PLAN!
- Baseline UDS
- Reg Random testing – Pain Physician, ASAM guide for monitoring those using medications for treatment of addiction
- Pill Counts
- Monitor Aberrant Behaviors
- Sleep assessments
Again, there is more to protecting your practice, your patient and your community. This is a good start.
I truly believe that together, TOGETHER, we can be the change!!
We CAN IMPACT THE GREATEST DRUG EPIDEMIC just by implementing a few simple steps.
CAST the STONE!