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.

Photo by eberhard grossgasteiger on Pexels.com

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

Published by pcmed1119

I'm an Anesthesiology & Pain management-trained physician who has been professionally/clinically involved with/practicing in the field of opiate addiction medication-assisted treatments since 2006. I'd like to share my knowledge, perspectives and experiences here to benefit those interested in Opioid use disorder medication-assisted treatments and related issues.

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