UPMC Physician Services Division
UPP-General Internal Medicine Policy for
Long-Term Use of Opioid Pain Medication
Opioid pain medications include, but are not limited to, Percocet, oxycodone, Oxycontin, morphine, Ms-Contin, Dilaudid, hydrocodone, hydromorphone, Vicodin, codeine, Stadol, fentanyl, Darvocet, and methadone.
The goals for using these medications are (1) to relieve suffering, (2) to improve functioning during the day, and (3) work along with other treatments to allow your body to heal as much as possible. The goal of these medications is to ease pain and to improve function. They will not necessarily completely eliminate pain. Some pains do not respond well to opioid medicine. If opioid medicines do not seem to be meeting the goals, the medicines should be stopped.
This class of medicines can produce the following adverse effects: drowsiness, nausea, confusion, constipation, tolerance (requires more and more of the medicine to provide the same amount of pain relief), physical dependence (a withdrawal syndrome that occurs when patients stop using the medicine abruptly), increased sensitivity to all pain, and addiction (loss of control over the amount of medicines used, constantly seeking more medicine, and adverse effects on important portions of the patient’s life).
State and federal law regulate prescribing opioid pain medicine. Therefore, to minimize the chance of harm to our patients from these medications, UPP-General Internal Medicine has adopted the following policies:
· Office procedures:
o By state and federal law, many opioid prescriptions can only be written for one month at a time, without any refills. When physicians see patients who are on on-going, stable doses of opioids, the physicians will write enough prescriptions for the patient to last until the next scheduled office visit. Prescriptions that are not needed at the time of the visit will be given to the nurse until they are due. The pick-up date for these prescriptions will be given to the nurse and to the patient.
o Refills of opioid prescriptions will only be made at the time of an office visit or during regular office hours by your Primary Care Provider (PCP) or the covering physician (if the PCP is away). No refills will be available during evenings, weekends, or holidays.
o Any lost, stolen, or destroyed medications or prescriptions for opioids will not be replaced.
· Physician responsibilities:
o To treat the patient’s pain, considering all available options for pain management, including non-opioid medications, physical therapy, behavioral pain management, referral to a pain clinic, neurosurgical evaluation, weight loss, emphasizing treatment methods with proven effectiveness.
o To clearly state to the patient the proper way to use the medication, in terms of dose and frequency, and to prescribe enough medication to last until the next appointment or some other designated time.
o To have prescriptions available in the office to pick up at the agreed upon time.
o To monitor for side effects from the medication.
o To conduct random urine screens to monitor for medication use.
o To periodically reassess pain issues and adequacy of treatment.
· Patient responsibilities:
o To inform the physician regarding all medications being taken.
o To designate a single pharmacy for filling opioid prescriptions.
o To inform the physician if the pain plan is inadequate, and not to take extra pain medication without first obtaining the agreement of the physician.
o To not receiving opioids from any other physician outside of this practice.
o To not use the Emergency Department to obtain opioid pain medication.
o To not use of illegal controlled substances, including marijuana, cocaine, or illegally obtained prescription drugs.
o To comply with urine screening when ordered by the physician.
o To not share, sell, or trade medication with anyone.
o To consider all available treatment options for pain, including non-opioid medications, physical therapy, behavioral pain management, referral to a pain clinic, neurosurgical evaluation, weight loss. Although patients always retain the right to refuse any specific intervention, the physician may decline to prescribe opioid medication if they are not in the context of a multifaceted approach to the pain problem.
If any of these conditions are not met, either the patient or the physician may terminate the relationship.
My signature below confirms that I understand the policies listed above. Furthermore, I give my physician and the pharmacists at my pharmacies permission to discuss my care with each other.
Signature of patient: ______Date: ______
Signature of Primary Care Physician:______Date: ______
Designated Pharmacy:______
Pharmacy Address: ______
Pharmacy Phone: ______