A Letter Released to Physicians on July 9, 2007

Opiate Abuse on the Rise

Abuse of prescribed opiates has been on a major upsurge in the United States.¹ From 1990 to 2002, the mortality rate from unintentional drug poisoning more than doubled. Opiates were the most common cause of overdose listed on death certificates in 2002. Opioids were implicated in more deaths than cocaine or heroin. This upsurge coincides with increases in opiate prescriptions.

Despite the fact that medical experts frequently voice concerns over rampant under-management of pain, hundreds of prescribers are investigated every year for violations of the Controlled Substances Act.² About 75% of investigations result in authoritative action such as revocation of DEA registration. When managing moderate to severe pain, concerns over potential harm to the patient or community and concerns over our socio-legal environment should both be addressed thoroughly. An earlier article summarizing documentation requirements can be found on the website: TaubMD.com. Practitioners are expected to remain vigilant for signs of potential illicit use of prescribed opiates. Warning signs include:

• Using more opiates than prescribed
• Seeking euphoria from opiates
• Seeking relief from anxiety from opiates
• Soliciting opiates from more than one provider
• History of drug / alcohol abuse - both personal and in immediate family^3,4
• Resistance to therapy changes
• Lost or stolen prescriptions
• Missed appointments

Neither history of drug abuse, current addiction, nor fear of unjust persecution should dissuade prescribers from thoroughly managing any patient’s pain. However, we can serve our patients while still implementing precautions that will protect patient, community, and provider. The private practice of Neal S. Taub MD, Board Certified in Pain Medicine, may be able to assist in a number of ways.

Second Opinions: If you are providing long-term pain management from your practice, a written and filed second opinion from a physiatrist board certified in pain management can provide assurances to you, your patient, and any third party. Written second opinions can confirm that your plan of care, drug choices, and dosages are reasonable and appropriate.

Interdisciplinary Management: When patients want to continue under your care, but you want to hear management options and opinions from a specialist, consider a referral to Dr. Taub. Dr. Taub can examine your patient and confer with you by telephone to suggest alternative means for managing your patient’s pain.

Pain Management: Many physicians prefer to let a specialist manage a patient’s chronic, moderate to severe pain while maintaining a relationship with the patient for other primary care. In his referral-based, physiatry practice, Dr. Taub routinely manages specific problems under the physiatry realm of expertise while leaving primary care in the hands of the referring practitioner. Because Dr. Taub manages multiple chronic pain cases, his practice has in place well-established opioid documentation and follow-up procedures including routine drug testing for all patients on opiates.

Board certified in pain medicine, ABPM&R. At his private practice in Charlotte, North Carolina, Dr. Taub can help with your chronic pain patients.

References:

1. Reuters Health. “Opiates a Leading Cause of Increased Mortality Rates Due to Drug Overdose.” Pharmacoepidemiol Drug Saf; July 25, 2006.
   
2. McCarberg B, et al. “Managing Pain: Dispelling the Myths. Video CME program. Leawood, Kan.: American Academy of Family Physicians, January 2003.
   
3. Tsuang MT, Lyons MJ, Eisen SA, et al. Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs. Am J Med Genet. 1996;67:473-477.
   
4. Meller WH, Rinehart R, Cadoret RJ, Troughton E. Specific familial transmission in substance abuse. Int J Addict. 1988;23:1029-1039.