Mowles points to the importance of documenting the five “As” for assess- ing chronic pain patients on opioids. They stand for: ■■
affect (document affect and mood, such as any self-reports of depres- sion or anxiety);
■■ ■■
analgesia (what is needed for ade- quate pain relief);
activities of daily living/psychologi- cal functioning (based on individual patient desires and goals);
■■ ■■
adverse effects (any the patient may be experiencing); and
aberrant behaviors (e.g., misuse, abuse, diversion).
“Due to the currently high preva- lence of prescription drug abuse and the addictive potential of opioid medi- cations, assessment of patient risk for misuse, addiction or diversion of med- ications is critical to ensuring the best possible patient care with the least risk for adverse outcomes,” Mowles says. ASCs should make sure their affil- iated practices are doing their part to protect
patients, Glaser says. “Our
practices use risk mitigation tools, such as urine testing, to make sure opi- oids are properly prescribed to patients who need them.” Mowles adds, “All of the prescrib- ers of controlled substances must adhere to a code of conduct dictated by national and state standards for controlling prescriptions. Those poli- cies are imperative. ASCs have a role in compliance as they are regulated to perform medication reconciliation.”
Cater to a Need Where ASCs might be in the best position to help patients—and them- selves—is through expanding access to care, Glaser says. “When someone is hurt, it is all about providing treat- ment as soon as possible. My career is devoted to trying to change the para- digm so people who are hurt have their care managed by interventional pain management physicians. We know all of the diagnostics, all of the symptom
Physicians Urge Caution on New Opioid Regulations
With the opioid crisis in the spotlight, lawmakers are weighing whether to enact new regulations to better control abuse. In June, US Department of Health and Human Services (HHS) Secretary Tom Price, MD, hosted listening sessions with addic- tion specialists, providers and representatives of treatment facilities to gather recommendations for ways to address the epidemic. In July, US Food and Drug Administration (FDA) Commissioner Scott Gottlieb stated that “reducing the scope of the epidemic of opioid addiction is my highest im- mediate priority” and called on his FDA colleagues to examine the agency’s opioid regulations.
“When faced with a significant problem, there is a desire to act,” says pain man- agement specialist John Broadnax, MD, co-founder and co-owner of Advanced Pain Institute of Texas in Lewisville, Texas. “While that is good, sometimes there is a tendency to act without a clear direction. We first need to do a better job of understanding the totality of the opioid crisis —the many issues contributing to it—before we start to pass extensive central legislation and policy.”
Eric Anderson, MD, also a pain management specialist and co-founder and co- owner of Advanced Pain Institute of Texas, says regulations must take into con- sideration their potential effects. “If you look at patients coming off opioids, the problem is they often gravitate toward illegal substances like heroin. There are multiple levels to what is happening, where and why. All should be examined closely before new regulations are put in place.”
If not crafted properly, new laws have the potential to harm patients, notes pain management specialist Scott Glaser, MD, co-founder and president of the Pain Specialists of Greater Chicago, with locations throughout Illinois. “Regulations cast a broad net. States are coming up with their own regulations, such as three-day limits on medications for acute pain. How many people have hurt their back and been better in three days? You also need to consider people who are safely on higher doses of medication because they have developed higher tolerances over the years. They are getting affected as well.
“Regulations are always instituted with good intentions,” he concludes, “but as the proverb states, ‘The road to hell is paved with good intentions.’”
management. We know what to do to make sure patients receive appropri- ate treatment. We need access to ASCs that are willing to work with us so we can move quickly when we have patients with severe pain.” To make that a reality, ASCs may need to evaluate their staffing and hours of operations, he says. “I am encouraging the ASCs I work at to allow me to add patients onto the next day’s schedule as late as possible the day before and be prepared to provide
the staff I need to treat these patients. That may require running a little later or bringing people in a little earlier. “I would also like my ASCs to offer some Saturday hours,” he continues. “There are people in bad pain who do not want to take a day off from work. We have many patients asking for that weekend option.”
Broadnax says he would like to see a concerted effort by ASCs to consider alternatives to opioids for controlling patient pain. “That can
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