Define Chronic Opioid Therapy

[NOSfan]

How would you, or at what threshold would you, define a patient as being on Chronic Opioid Therapy?

And for instance, what about the patient taking opioids only 1 or 2 times a week.....etc.

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[myrandom2003]

scheduled visits for refills every 30 to 90 days

 

[Nodolor]

Anyone needing opioids longer than 3 months is Chronic in my book

 

[Ducttape]

1. anyone calling in for a "refill".

2. anyone getting more than a 1 week supply for a non-acute process such as fracture and surgery.

 

[SommeRiver]

...patient's been on opiates for awhile IMO.

 

[lobelsteve]

Daily use > 1 Rx

 

[BobBarker]

If they are taking a pill/day or even 15/month.

 

[Ferrismonk]

No hard number, but if they take it at least a few days a week for more than 1-2 weeks or require/want a second script, that's chronic.

 

[epidural man]

This is a great question. When we were defining our Long-Term Opioid therapy program, I argued for a floor - because I think the person who takes an occasional Tramadol (30 pills every 3-4 months) does NOT need to be on the program.

Unfortunately, I was shut down.

 

[Drd105]

This is a great question. When we were defining our Long-Term Opioid therapy program, I argued for a floor - because I think the person who takes an occasional Tramadol (30 pills every 3-4 months) does NOT need to be on the program.

Unfortunately, I was shut down.

I emailed a similar example to my state Board of Medicine - do I UDS the #30 tramadol per year person? and they responded that UDS is required at least annually and they do not differentiate based on quantities consumed. So for me those people sign the consent/agreement q6 mos and get UDS at least q6 mos. I just tell them it's to protect my license and almost no one minds. It kind of makes sense because it's hardly any tramadol for a year, however it's a hell of a lot more tramadol than the zero I take in a year.

 

[epidural man]

I emailed a similar example to my state Board of Medicine - do I UDS the #30 tramadol per year person? and they responded that UDS is required at least annually and they do not differentiate based on quantities consumed. So for me those people sign the consent/agreement q6 mos and get UDS at least q6 mos. I just tell them it's to protect my license and almost no one minds. It kind of makes sense because it's hardly any tramadol for a year, however it's a hell of a lot more tramadol than the zero I take in a year.

The point of UDS is to prevent diversion and abuse. It’s weird that the board thinks a person getting 30 pills of tramadol is selling them, or abusing them.

 

[SommeRiver]

Never UDS a 30 tab per yr tramadol pt, and I do not automatically UDS all of my pts.

My 75 yo pts with bad backs on Norco BID don't reflexively get UDS just because they take Norco BID.

At one point I was doing quartery urine.

 

[Drd105]

Never UDS a 30 tab per yr tramadol pt, and I do not automatically UDS all of my pts.

My 75 yo pts with bad backs on Norco BID don't reflexively get UDS just because they take Norco BID.

At one point I was doing quartery urine.

I was not doing it either until I talked to the Board.

 

[Ferrismonk]

Never UDS a 30 tab per yr tramadol pt, and I do not automatically UDS all of my pts.

My 75 yo pts with bad backs on Norco BID don't reflexively get UDS just because they take Norco BID.

At one point I was doing quartery urine.

You're going against established guidelines then. Just so you're aware. Most state at least annually for low risk people.

 

[SommeRiver]

You're going against established guidelines then. Just so you're aware. Most state at least annually for low risk people.

I bet I do them yearly TBH

 

[Ducttape]

there are legal "guidelines" not only from the CDC but from FSMB and each state's independent DOH.

if it is a controlled substance that I am prescribing, then I follow legal aspects of care, not medical aspects.





edit sorry: I follow not just medical aspects...