The past two decades have seen skyrocketing rates of opioid dependence, overdoses, and deaths. This public health crisis stems largely from the overprescribing of powerful narcotic painkillers. In seeking solutions, attention has turned to pain management clinics since they frequently prescribe opioids. Legitimate pain clinics like Utah-based KindlyMD are responding by dramatically changing their approach to opioid therapy. They now prioritize harm reduction and prevention of misuse.
Understanding the Crisis
The roots of the current opioid epidemic trace back to the late 1990s. At that time, pharmaceutical companies reassured doctors that their narcotic pain relievers were safe with a low risk of addiction. This led to widespread prescribing of opioids for all types of pain. But it quickly became clear opioids carried a far higher addiction potential than advertised. Millions became dependent on prescription opioids as well as heroin and illicit fentanyl.
Pain Clinics Take Action
Today’s pain clinics fully acknowledge their role in the early proliferation of opioids. They understand the need for vastly more judicious prescribing. Progressive pain clinics now follow strict protocols designed to curb opioid misuse, including:
Careful Patient Selection
Clinics screen prospective patients thoroughly for risk factors of addiction:
- Personal or family history of substance abuse.
- Mental health conditions like depression.
- Younger age.
- History of legal issues.
- Smoking status.
Those deemed high-risk are either not prescribed opioids or monitored extremely closely.
Comprehensive Evaluations
Prior to recommending opioids, doctors perform complete diagnostic workups to confirm an indication requiring narcotics. Validated questionnaires also identify mental health issues or unstable social situations that elevate risk.
Reviewing PDMP Data
Providers are diligent about checking their state’s prescription drug monitoring program (PDMP) database prior to prescribing any controlled substance. PDMPs log all prescriptions filled by a patient, alerting doctors to potential “doctor shopping” or dangerous combinations.
Limiting Dosages and Duration
Clinics restrict opioid dosages to the minimum necessary for reasonable pain control. Long-acting opioids especially are prescribed conservatively. Short prescription durations with frequent reassessment ensure appropriateness.
Trying Non-Opioid Options First
Non-opioid therapies (NSAIDs, antidepressants, injections, physical therapy, medical marijuana, etc.) are now exhausted before considering opioids. Most clinics recognize they can effectively manage chronic pain without narcotics.
Patient Education
To prevent misuse, clinics instruct patients to store medications securely, never share with others, follow directions precisely, and properly dispose of unused pills. Patients also learn to recognize worrisome warning signs like medication cravings.
Careful Monitoring
Ongoing follow-up, pill counts, UDS testing and PDMP checks are standard. Any suggestion of inappropriate use leads to discontinuation of opioids. More frequent office visits keep communication open.
Tapering Off Opioids When Able
For patients stable on other therapies, clinics work to slowly taper off opioids. This “de-prescribing” approach reduces exposure and dependence. Patients are tapered under medical supervision to avoid withdrawal symptoms.
Offering Addiction Treatment
Some progressive clinics now screen for substance abuse issues and initiate Medication Assisted Treatment using buprenorphine or methadone along with counseling. Treating addicted patients maintains crucial trust while fighting the opioid epidemic.
Conclusion
Thanks to such stringent safeguards, legitimate pain clinics largely stopped contributing to the crisis even as the death toll continued climbing. In fact, most fatal overdoses today involve illicit heroin and fentanyl, not prescribed medication. Still, pain specialists recognize their responsibility to prevent any possible misuse. Through careful prescribing and vigilant monitoring, today’s pain clinics aim to provide relief to suffering patients while upholding their oath to “first, do no harm”.
Pain specialists have an important voice in this ongoing discussion. Through their state medical societies and national groups like the American Society of Interventional Pain Physicians (ASIPP), pain doctors advocate for balanced solutions that prevent opioid misuse while still allowing access for appropriate patients.
