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Pharmacy expert on opioid issues: Check the guidelines against your own practices

Recently Part B News has in a number of articles and a blog post looked at best practices for providers confronting the national opioid crisis and its effect on their practices and their patients. Sean Karbowicz, PharmD., R.Ph., a longtime pharmacy executive who has worked with  BlueCross BlueShield and OmedaRx and now serves as general manger of the MedSavvy consultancy, has more to add.

Part B News: Does the average prescribing provider have anything to look out for when prescribing opioids?

Sean Karbowicz: The Federation of State Medical Boards has published best practices for prescribing opioids. The CDC also has produced guidelines. These guidelines and best practices can help identify patients at risk for opioid addiction and encourage conversations between providers and patients that can uncover potential risks in therapy. 

Do providers have to tighten up their documentation for patients who are prescribed opioids?

The guidelines do suggest ample documentation to protect both the provider and patient -- specifically, with regard to the “informed consent” discussion. Additionally, some health plans have embraced these guidelines and make coverage contingent upon the steps in these guidelines being documented in the patients’ chart notes.

Do providers have to change their way of dealing with patients, pharmacies and insurers?

Heavy marketing of new opioid formulations in the late 1990s and early 2000s, combined with a new focus on treating pain as the “5th vital sign,” fueled a tremendous increase in the quantities of opioids dispensed in the U.S., despite the lack of evidence this treatment approach improved patient outcomes. The risks and unintended consequences of this prescribing behavior has come into focus. While many guidelines have been in place prior to the opioid epidemic, the current environment of abuse, addiction and overdoses due to opioids has heightened the importance of prudent and judicious prescribing.

This also requires a focus on adequate assessment of the patient, and ongoing use of nonpharmacologic treatment. Effective therapies for chronic pain are time-consuming, patients with chronic pain are often very complex and it’s often easier to write a prescription. Because of the current environment of the opioid epidemic, providers will absolutely need to revisit the scientific evidence of prescribing chronic opioids and re-evaluate how they prescribe.

Blog Tags: compliance
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