F. Is There Clinical Justification For Prescribed Opioid Or Sedative-Hypnotic Use?
OBJECTIVE
Clarify the underlying clinical condition being managed through opioid or sedative-hypnotic use.
ANNOTATION
1. Distinguish patients with legitimate pain and/or anxiety disorders who develop physiological tolerance during long-term use of prescribed medications, from those with markers of "addict behavior" (e.g., seeking medications for other than pain, seeking prescriptions from multiple providers, increasing the dose without consultation, frequent “losses” of medications, intoxication, or buying medication on the street). 2. Evaluate opioid dependent patients for severe acute or chronic physical pain that may require appropriate short-acting opioid agonist medication, in addition to the medication needed to prevent opioid withdrawal symptoms (see also www.asam.org/ppol/opioids.htm for American Society of Addiction Medicine policy statement). 3. Consider patients with a history of substance use disorders (SUDs) to be at elevated risk of receiving inadequate therapy for pain or anxiety. 4. Prescribe opioid analgesic medication (in cases of severe pain disorders) or sedative-hypnotic medication (in cases of severe anxiety or seizure disorders), when medically indicated, even if the patient has a history of SUD and provided that the patient’s medical condition is: · Diagnosed correctly, including physical examination, review of past records, and appropriate consultation · Acute enough to justify the use of opioid analgesics · Documented in the clinical record 5. Consult with an addiction specialist, if uncertain whether to prescribe an opioid analgesic or sedative-hypnotic medication to a substance dependent patient with a current or historical SUD.
EVIDENCE TABLE
QE = Quality of Evidence; R = Recommendation (See Introduction)
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