Balanced opioid Rx in patients at risk for   substance abuse      Earl Quijada, MD        May 1, 2012
Trust
Ri                                    t                                 en      sk                                  m     ...
1.                                                    Root of aberrant                                                    ...
More Predictive                                                                                                           ...
Less Predictive                                                                                                           ...
2. Low Risk• No past/current                                 Moderate Risk                                       • History...
3.+ forensic results legally rx med                                                            - compliance results       ...
4.VAS is useless without a range            30%
5.  Addicted patients demonstrate decreasein function with opioidsPhysical, family, social, emotional, and spiritual
6.Adverse effects stabilize except constipation      Sedation, psychic effects
Ri                                    t                                 en      sk                                  m     ...
Balanced opioid rx in pt with substance abuse
Balanced opioid rx in pt with substance abuse
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Balanced opioid rx in pt with substance abuse

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Tools to help evaluate risks and benefits in prescribing opioids. Like truing a wheel.

Published in: Health & Medicine, Education
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Balanced opioid rx in pt with substance abuse

  1. 1. Balanced opioid Rx in patients at risk for substance abuse Earl Quijada, MD May 1, 2012
  2. 2. Trust
  3. 3. Ri t en sk m str ss ati se fy AsAberrantbehavior Analgesia Trust t AD ec eff L’s se UDS r ve Ad
  4. 4. 1. Root of aberrant rug behavior Specific d Ri sk st ra tif y Psychiatric Pseudo-addiction Social Criminal Addiction 40% Passik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.
  5. 5. More Predictive rug Specific d Ri skIllicit drugs st Forgery ra Selling tif Injecting y Stealing Psychiatric Criminal Pseudo-addiction Social AddictionPassik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.
  6. 6. Less Predictive rug Specific d Ri Hoarding sk Physician hop st ra Psychic tif Aggressive y effects complainingSpecific drug Psychiatric Criminal Pseudo-addiction Social Addiction Passik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.
  7. 7. 2. Low Risk• No past/current Moderate Risk • History of treated High Risk • Active substance history of substance abuse substance abuse abuse • Active addiction• Noncontributory • Significant family history of substance • Major untreated family history of psychological abuse substance abuse disorder • Past/comorbid• No major or • Significant risk psychological untreated disorder to self and psychological disorder practitioner < 1% ~ 45% Webster LR, Webster RM. Pain Med. 2005;6:432-442.
  8. 8. 3.+ forensic results legally rx med - compliance results med bingeing OTC UDS diversion illicit drugs insufficient sensitivity Heit HA, Gourlay DL. J Pain Symptom Manage. 2004;27:260-267.
  9. 9. 4.VAS is useless without a range 30%
  10. 10. 5. Addicted patients demonstrate decreasein function with opioidsPhysical, family, social, emotional, and spiritual
  11. 11. 6.Adverse effects stabilize except constipation Sedation, psychic effects
  12. 12. Ri t en sk m str ss ati se fy AsAberrantbehavior Analgesia Trust t AD ec eff L’s se UDS r ve Ad

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