ATTENTION – all clinicians who engage in the noble, but angst-engendering, practice of prescribing opioids for chronic pain…. For those prescribers who wonder how or if they can ever get their patients to use less opioid, this blog post is for you.
Chronic Opioid Reduction Empowerment Program
C. O. R. E.
“Established patients already taking high dosages of opioids, as well as patients transferring from other clinicians, might consider the possibility of opioid dosage reduction to be anxiety-provoking, and tapering opioids can be especially challenging after years on high dosages because of physical and psychological dependence. However, these patients should be offered the opportunity to re-evaluate their continued use of opioids at high dosages in light of recent evidence regarding the association of opioid dosage and overdose risk.” – CDC Prescribing Guideline
* KENTUCKY’s PAIN REGULATIONS require PHYSICIANS to refer the patient to addiction management if: (1) There has been no improvement in function; (2) Therapy has produced significant adverse effects; or (3) The patient exhibits inappropriate drug-seeking behavior or diversion.
**INDIANA’s ATTORNEY GENERAL directs PRESCRIBERS to “Develop a personal relationship with a PAIN PHYSICIAN. The pain specialist can act as your THERAPEUTIC SHIELD.”
As a PAIN and ADDICTION specialist I can assess your most challenging patients and develop plans to reduce or eliminate the need for opioids. My C. O. R. E. program can act as your “therapeutic shield.”
C.O.R.E. is a collaborative approach to caring for the pain patient on chronic opioid therapy. The goal is to reduce dependence on opioid pain medication. The program begins with an evaluation by Dr. James Patrick Murphy – Pain and Addiction Specialist. Then, a plan to minimize opioids is developed that both the patient and referring physician find acceptable. At the conclusion of the C.O.R.E. program the patient returns to the referring physician with Dr. Murphy providing support and guidance as needed. This ongoing relationship with Dr. Murphy has been described by Indiana’s Attorney General as the prescribing physician’s THERAPEUTIC SHIELD, but you will come to think of it as your peace of mind.
BEFORE WRITING ANOTHER Rx FOR OPIOIDS YOU OWE IT TO YOURSELF TO CALL
** First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain
New: Indiana’s Pain laws, limiting opioid prescribing to seven days (added to post on 6.29.17) http://iga.in.gov/static-documents/b/9/5/2/b9523207/SB0226.05.ENRH.pdf
Pain Management Opioid Taper Decision Tool A VA Clinician’s Guide:
Links of interest: