Pain medication can help back pain patients on the road to recovery, but spine surgeons and specialists across the country are now faced with several challenges to ensure patients adhere to their regimen without abusing their prescription or diverting the pills somewhere else.
"The obvious challenge, especially with workers compensation patients, to make sure they are taking them," says Bryan Oh, MD, an orthopedic spine surgeon at BASIC Spine in Newport Beach, Calif. "Every physician has those patients and every spine and pain practice deals with this problem."
Here are five ways to develop a successful drug screening program for spine and back pain patients.
1. Develop tests that are sensitive and specific. The most successful tests for compliance to prescription pain medication can produce quality data in real time. "The problem with some tests is that you screen the patients one day, but it takes time to get results back and no one follows up with the patient," says Dr. Oh. "There are all sorts of criminal behavior that can go undetected without follow-up, and it's extremely bad for the patient. There are also acute economic costs to drug abuse."
2. Find out if patients have seen other physicians recently. Have all the information available about patients before their appointments. In California, physicians have access to the CURES report, which updates pain patient visits in real time. "Look at the CURES report before the patient is in your office so you have all their information available and you can hold them accountable," says Dr. Oh. "The goal is to improve patient healthcare and at the same time minimize criminal activity. If we can do that, we can clean up a lot of problems."
3. Sign an opioid agreement. It has become standard in many practices to develop an opioid agreement for patients to sign before prescribing pain medication. "Every patient has to sign our agreement, otherwise we don't want to see them," says Dr. Oh. "We prescribe these drugs and have a right to test them any time. We also clarify in the agreement that they can't go 'doctor shopping.'"
The practice also has access to the CURES report and incorporates it into the opioid agreement. "If we see someone is violating the agreement — such as patients seeing other doctors — then we can catch them red-handed," says Dr. Oh. "That's a big problem. We are also trying to develop a real-time urine test so we can test the patients on the spot."
4. Educate patients before the first prescription. Education on the proper use and potential for abuse of prescription pain medication begins at the moment the drugs are prescribed at BASIC Spine. "We tell them there are possibilities of addiction and give them an expectation that our prescription is a short term fix," says Dr. Oh. "In the post-op period, you have to give pain medication. However, if we prescribe more than a few doses they have to see a pain physician at our practice as well as the pain psychologist."
These specialists assess patients so they have the right expectations about pain medication and relate the dangers of medication addiction. They can also help patients develop strategies for pain relief without relying too heavily on pain medication.
5. Refer chronic pain patients to other options. Patients with chronic pain shouldn't take pain medication long-term. Instead, work with them to find other options such as spinal cord stimulators, functional restoration programs or neuromodulation to relieve their pain. "We work to create those programs in our practice so patients have those options available," says Dr. Oh.
Doctor Bryan Oh is board certified in Neurological Surgery and received his medical training at Stanford University with a residency in neurosurgery and fellowship in spine surgery at the University of Southern California in Los Angeles.
Dr. Oh was a faculty member at the University of Texas at Houston Medical School and was Director of Neurotrauma for the busiest Level One Trauma Center in the United States.
He is a reviewer for the journals Neurosurgery and World Neurosurgery as well as a member of several prestigious societies, including the Congress of Neurological Surgeons and the American Association of Neurological Surgeons. Please follow him on facebook, twitter, youtube and google+.
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