Zion Pain Management Controlled Substance Policy
Sometimes pharmaceutical narcotics and other prescription controlled substances are essential to the effective treatment and relief of pain. Here at Zion Pain Management Center we are committed to providing our patients with pain relief by any medically appropriate and legitimate means including the use of controlled substances.
However, we also recognize that the abuse of pharmaceutical narcotics and other prescription controlled substances is a serious problem. According to the Department of Health and Human Services, the number of Americans 12 or older who have engaged in the illicit use of pain relievers during their lifetimes has risen to more than 31 million. Zion Pain Management Center’s policy on prescribing controlled substances is simple: we strictly abide by all federal and state laws and regulations and cooperate fully with law enforcement agencies to prevent the illicit use of drugs. Any and all prescriptions for controlled substances at Zion Pain Management Center will be for legitimate medical purposes only. All prescriptions will be based on clear documentation of unrelieved pain and will follow these guidelines:
- Evaluation of the Patient—a medical history will be taken and physical examination conducted and placed in the patient’s medical record. The medical record will document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and any history of substance abuse. The medical record will also document the presence of one or more recognized medical indicators for the use of controlled substances.
- Treatment Plan—a written treatment plan will be placed in the medical record and that plan will state clear objectives for the determination of treatment success (for example pain relief and improved physical and psychosocial function). The plan will indicate whether any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician will adjust drug therapy to the individual needs of the patient. Other treatments may become necessary.
- Informed Consent and Agreement for Treatment—the physician or nurse practitioner will discuss the risks and benefits of the use of controlled substances with the patient (or person designated by the patient or the patient’s surrogate or guardian). The patient will be allowed to receive prescription controlled substances from one physician and pharmacy only. All patients receiving controlled substances will enter into a written agreement that clearly outlines the patient’s duties and responsibilities (including urine/serum medication level screening upon request) and clearly states the reasons for which drug therapy will be discontinued.
- Violation of Informed Consent and Agreement for Treatment (see 3 above)—in the event that a patient fails to abide by the terms and conditions of his or her written medication agreement, Zion Pain Management Center reserves the unconditional right to refuse further drug therapy. In such a case Zion Pain will continue to make non-drug therapies and procedures available to the patient, should the patient desire them.
- Periodic Review—the physician will periodically review the course of pain treatment and any new information about the source of the pain or the patient’s state of health. Continuation or modification of the use of controlled substances for pain management will depend upon the physician’s evaluation of the patient’s progress toward treatment objectives. Satisfactory progress may be indicated by the patient’s decreased pain, increased level of function or improved quality of life. Objective evidence of improved or diminished function will be monitored and information from family members or other caregivers will be considered in determining the patient’s response to treatment. If the patient’s progress is unsatisfactory, the physician may determine to discontinue the current treatment plan and may consider use of other treatments.
- Consultation—the physician may decide to refer the patient for additional evaluation and treatment in order to achieve the treatment objectives. Special attention will be given to those patients who are at risk for medication misuse, abuse or diversion. The management of pain in patients with a history of substance abuse or with a psychiatric disorder will require extra care, monitoring, documentation and consultation with or referral to an expert in the management of such patients.
FREQUENTLY USED PAIN MEDICATION TERMINOLOGY
The following terms are often used in the treatment and management of pain.
Pain is an unpleasant sensory and emotional experience that accompanies actual or potential tissue damage. Acute Pain is the intense pain that typically follows from injury, disease and invasive procedures.
Acute pain is normally time limited. Chronic Pain is pain that lasts beyond the normal course of a disease or the healing of an injury.
Chronic pain may persist for months or even years. Addiction is an ongoing condition or disease that has genetic, psychological and environmental causes. An addict may manifest lack of control, craving, compulsive use, and continued use despite harm.
Addiction is different from physical dependence and tolerance.
Physical Dependence is an unpleasant physical condition that can be produced by abrupt cessation of drug use, rapid dose reduction, decreasing blood-drug level, or the administration of an antagonist to the drug. It is different from addiction.
Substance Abuse is the use of any substance for a non-therapeutic purpose or the use of a medication for some purpose other than that for which it was prescribed. Tolerance is a condition that results from the regular use of a drug. In this condition a person requires an increased dosage to achieve the same effect.
Tolerance may or may not occur with the use of opioids and is not the same thing as addiction.