A Letter Released to Physicians on August 4, 2006

Seven Requirements for Prescribing Opiates

Hundreds of physicians are investigated every year for violations of the Controlled Substances Act. About 75% of investigations result in authoritative action. In 2001, 79 practitioners lost their Drug Enforcement Agency (DEA) registration pursuant to investigations.¹ While almost 100% of practitioners do a conscientious job of prescribing opiates, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine publicly hold the position that physicians underutilize opioids for nonmalignant pain due to concerns regarding potential harm to the patient and fear of third party sanctions. Both of these concerns are legitimate and should be taken seriously. As an MD who is board certified in pain medicine, Dr. Neal S. Taub offers his services to practitioners seeking a second opinion on treatment plans involving opiates and to practitioners considering referral to a pain specialist.

A report on the 2002 meeting of the FDA Anesthetic and Life Support Drug Advisory Committee1 concluded that physicians need to meet seven documentation requirements when making opiates part of a nonmalignant pain management treatment plan:

1. Document appropriate history and physical exam
2. Document a “recognized” medical indication for prescribing the drug
3. File a written treatment plan
4. Discuss with the patient and document the risks and benefits of the medication and execute a signed pain management treatment plan agreement
5. Conduct and document periodic review of progress at reasonable intervals
6. Maintain complete and accurate records
7. Monitor more closely those patients with a history of substance abuse

It may be more beneficial to monitor all patients taking opiates for substance abuse rather than selecting a group of patients for special attention. Furthermore, in an article published by the New England Journal of Medicine in 2003, doctors Ballantyne and Mao recommended that practitioners should first “establish firmly that nonopioid therapy has failed.”²

Practitioners may find it beneficial to obtain a second opinion before beginning a treatment plan involving opiates. By referring your patients to Neal Taub, MD, ABPM&R, you can document an expert second opinion that other reasonable pain management options have been exhausted, that the proposed opioid is the best choice for the patient’s presentation, and that the patient has received adequate education for informed consent. Alternatively, if you have patients suffering from chronic pain, you can refer those patients to the private practice of Neal S. Taub, MD for specialized pain management which may or may not involve opioid analgesics. Because Dr. Taub manages a larger portion of chronic pain cases, Dr. Taub has in place a structured approach to opioid prescriptions including routine drug testing for all patients on opiates.

In either case, Dr. Taub’s private practice serves you as a referral based physiatry practice. Dr. Taub works on specific problems that fall under the physiatry area of expertise while coordinating with the referring practitioner as needed and leaving the patient under the referring practitioner for primary care.

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

References:

1. McCarberg B, et al. “Managing Pain: Dispelling the Myths. Video CME program. Leawood, Kan.: American Academy of Family Physicians, January 2003.
   
2. Ballantyne J, Mao J. “Opioid therapy for chronic pain.” N Engl J Med 2003; 349: 1943-53.