In the Clinic today…

Here’s the scenario:

Today, in the clinic I had an interesting interview with a client who is in medication-assisted treatment (using methadone) for opioid use disorder (OUD)/addiction. The core of the matter centered on whether it was OK for the client, who is also a chronic back pain sufferer, to be on a legitimately prescribed opioid medication, open-endedly (?) – no firm discontinuation plan, after a failed interventional procedure which caused a flare up in his pain. He states that he’s handling it well and that his appropriate use (as directed by his prescription – 3x daily) is being monitored by his Pain physician and the Clinic counselor. He doesn’t see an issue here…

What’s your opinion, is there an issue of concern here ??

My thoughts:

For me, this is a complex issue, as numerous questions and complexities arise in the context of chronic pain management utilizing opiates, in opioid addicted populations. Some of these issues are:

It depends! (on several factors, two of which I highlight below)

Location:

What might be acceptable for limited durations in certain settings, such as an in-patient facility, for example, might be less so or not at all acceptable, in others, such as in a less strictly monitored outpatient setting. 

Duration of use:

While short term use of opioids for acute pain conditions/flare-ups, even in the setting of OUD, such as perioperatively, trauma, etc is widely accepted. Is chronic opioid therapy for pain management ever acceptable for/in an opioid use disorder patient who is in recovery and abstinent or on opioid-agonist medication – assisted treatment ?

How I resolved the matter:

I asked the client to discuss the matter with his pain management physician and together implement a plan to be off the opioid pain medication within 90 days. I consider it a “judgement call” on my part and think it was a “safe decision” but certainly not the only possible decision.

Tell me what you think. Send comments to continue the conversation or begin new ones.
Stu.