Patients on chronic opioids

[KHE]

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I am an optometrist and like most providers in most communities in the USA, I see a number of patients who are on chronic opiates, almost always related to the usual suspects.....back, shoulder, neck pain. etc. etc.

But I'm very surprised at the number of patients who are ALSO taking benzos along with the opiates. My understanding is that this is a massive no-no.

Many of these people seem to be having their prescriptions renewed by their primary care doctor. I've encouraged them to speak to the PCP about being on both but it's obviously not my area of expertise.

How big of a problem is this? Are there scenarios where the two are used together?

 

[lobelsteve]

Chemical coping.
No, it is not OK.
Against CDC and FDA guidelines.
Attached is my informed consent and agreement for treatment which also includes info on this topic.

 

[KHE]

As an optometrist, what would you recommend I advise these patients to do other than what I am currently doing?

 

[powermd]

As an optometrist, what would you recommend I advise these patients to do other than what I am currently doing?

As an optometrist I would recommend you stay out of it, unless you want to lose these patients, and risk the occasional angry one dropping F bombs in your office. So not worth it, and thankfully not your problem.

 

[deleted185747]

I initially thought you said optimist 😉

 

[oreosandsake]

Chemical coping.
No, it is not OK.
Against CDC and FDA guidelines.
Attached is my informed consent and agreement for treatment which also includes info on this topic.

If you or your friends or relatives are rude, ugly, disrespectful, yell, raise your voice, curse, or threaten my staff, I will have to stop writing for opioids, narcotics, or controlled substances.

I think I know what you're saying, "ugly towards my staff..."

but hey, maybe plain ol' ugly is CI for narcs too =)

Great form Steve. thanks for sharing

 

[lobelsteve]

If you or your friends or relatives are rude, ugly, disrespectful, yell, raise your voice, curse, or threaten my staff, I will have to stop writing for opioids, narcotics, or controlled substances.

I think I know what you're saying, "ugly towards my staff..."

but hey, maybe plain ol' ugly is CI for narcs too =)

Great form Steve. thanks for sharing

I borrowed those words directly from AMPA.

 

[willabeast]

I am an optometrist and like most providers in most communities in the USA, I see a number of patients who are on chronic opiates, almost always related to the usual suspects.....back, shoulder, neck pain. etc. etc.

But I'm very surprised at the number of patients who are ALSO taking benzos along with the opiates. My understanding is that this is a massive no-no.

Many of these people seem to be having their prescriptions renewed by their primary care doctor. I've encouraged them to speak to the PCP about being on both but it's obviously not my area of expertise.

How big of a problem is this? Are there scenarios where the two are used together?

 

[willabeast]

They are used together most often to help induce general anesthesia for surgical procedures. This is often referred to as balanced anesthesia.

 

[DOctorJay]

They are used together most often to help induce general anesthesia for surgical procedures. This is often referred to as balanced anesthesia.

I tell patients this all the time. And then remind them that the anesthesiologist has full control over their airway while using these meds.


Sent from my iPhone using SDN mobile

 

[freddydpt]

I agree it's a massive no-no. It is one of the reasons I left my last job. There were too many hands in the kitchen with PCP's overprescribing benzos and patients demanding opioids - no psych available in the community. When those patients die, who is the FDA coming after? The opioid guy despite heavy documentation recommending against co-administration of these meds. Then the PCP gets pissed if you tell the patient they need to choose to be on one or the other... patient says the pain doc said "you are prescribing me the wrong/dangerous meds." It's a whole BS rat race in pain medication world. We should all just stick to interventions.

 

[Timeoutofmind]

As an optometrist I would recommend you stay out of it, unless you want to lose these patients, and risk the occasional angry one dropping F bombs in your office. So not worth it, and thankfully not your problem.

You are supremely unlikely to change any of this in any single patient you ever see given your profession and your level of medical interaction with these patients and their PCPs.

You are simply exposing yourself to risk and scrutiny by involving yourself in any way.

Hard to know when to fold em sometimes amigo...and when to walk away...and when to run!!!!! (As in this case). Can't have that Mother Teresa attitude here.

Good to know there are reasonable human beings out there who actually care about people though...

 

[clubdeac]

Curious, why does this even come up in your visits? You're taking care of their eyes right?

 

[Aether2000]

These patients are iatrogenic addicts that will vehemently defend their use of these medications regardless of statistics, risk, and counseling. Many are also using other dangerous substances concurrently including alcohol. Save your breath and leave them to their drug induced state of existence- you will only end up alienating these patients and having their hostility turn towards you for daring to suggest there may be a problem with the combination of drugs awash in their brains.

 

[KHE]

Curious, why does this even come up in your visits? You're taking care of their eyes right?

Yes, but obviously I get their medical history and what medications they are on.

You are supremely unlikely to change any of this in any single patient you ever see given your profession and your level of medical interaction with these patients and their PCPs.

Good to know there are reasonable human beings out there who actually care about people though...

All I've said to people regarding this issue is to check with the doctor prescribing their medications because usually those two types of medications aren't taken together and I leave it at that.

I'm not really looking to get "involved" other than I would prefer my patients not die accidentally and I was wondering what this group's perspective on what someone like me should be doing or saying to these people, if anything.

I was also just surprised at how often I see it and was wondering if there was some legitimate use of this combination that I wasn't aware of.

 

[Ducttape]

the most that i would do is take note of the medications as you do typically, and if you do see one that is intoxicated in your office, make sure he/she has a safe way to get home.

in these cases, contacting the PCP office may be wholy appropriate.

 

[VA Hopeful Dr]

in these cases, contacting the PCP office may be wholy appropriate.

Well appropriate, it won't matter. Either A) the PCP will just ignore it completely because they are busy or B) ignore it and get pissed that an optometrist would dare tell them how to practice medicine.

NB: my dad was an optometrist so I don't agree with the latter at all, but many of my colleagues do think that way.

 

[freddydpt]

All I've said to people regarding this issue is to check with the doctor prescribing their medications because usually those two types of medications aren't taken together and I leave it at that.

I think that's great. Keep up the reinforcement that patients should not be taking these medications together. Every little bit helps.

 

[painlove]

Chemical coping.
No, it is not OK.
Against CDC and FDA guidelines.
Attached is my informed consent and agreement for treatment which also includes info on this topic.

This is incredible. How have patients and PCPs and referrals responded with this policy? I read it and it is very strict, which is a good thing. How is your volume?
Awesome work, I appreciate your concern and diligence in doing your part for the opioid epidemic.

 

[lobelsteve]

This is incredible. How have patients and PCPs and referrals responded with this policy? I read it and it is very strict, which is a good thing. How is your volume?
Awesome work, I appreciate your concern and diligence in doing your part for the opioid epidemic.

10 new patients, 10 procedures, 8 follow ups tomorrow. In OR last night til 930. Started at 3. Implant, explant, implant and he wanted ipg up front, then kypho. Relaxed pace. I couldnt be busier but refuse to add extenders. Im a jerk. Im a saint. Same patient different day.

 

[VA Hopeful Dr]

10 new patients, 10 procedures, 8 follow ups tomorrow. In OR last night til 930. Started at 3. Implant, explant, implant and he wanted ipg up front, then kypho. Relaxed pace. I couldnt be busier but refuse to add extenders. Im a jerk. Im a saint. Same patient different day.

If you ever want to move to SC, let me know. I have literally dozens for doctors who would refer to you on day 1...

 

[clubdeac]

If you ever want to move to SC, let me know. I have literally dozens for doctors who would refer to you on day 1...

Where in SC? I'm looking at moving back to that area. And aren't you at the VA?

 

[VA Hopeful Dr]

Where in SC? I'm looking at moving back to that area. And aren't you at the VA?

Nope, that was from when I was an undergrad in Virginia.

I'm about to move back home to Spartanburg which has very few good pain docs, but Columbia (where I currently am) has a need for decent pain management as well.

 

[lobelsteve]

Nope, that was from when I was an undergrad in Virginia.

I'm about to move back home to Spartanburg which has very few good pain docs, but Columbia (where I currently am) has a need for decent pain management as well.

Columbia. I love that town on Live PD.

 

[VA Hopeful Dr]

Columbia. I love that town on Live PD.

That type of thing is part of the reason we're leaving...