Health care providers

Guidelines for clinicians on pain management, prescribing naloxone and treating opioid addiction.

Opioid prescribing/pain management guidelines  opioidscript

The Agency Medical Directors’ Group develops guidelines for medical providers caring for patients of state agency programs in WA State. The AMDG 2015 Interagency Guideline on Prescribing Opioids for Pain recommends best practices for opioid-based and non-opioid pain management to improve care of patients with chronic pain and to reduce their risk of addiction and overdose.

Along with the AMDG Guideline, five prescribing profession boards and commissions have adopted rules on the management of chronic, non-cancer pain:

  • Medical Quality Assurance Commission
  • Board of Osteopathic Medicine and Surgery
  • Nursing Care Quality Assurance Commission
  • Dental Quality Assurance Commission
  • Podiatric Medical Board

The relevant WACs for each profession can be found here.

Other pain management resources

  • The University of Washington Department of Anesthesiology and Pain Medicine’s Pain Medicine Provider Toolkit has a comprehensive list of clinical tools and patient education materials.
  • The University of Washington School of Medicine COPE program offers a suite of free CME courses  for primary care doctors, nurses, physician assistants, and other health care specialists who treat patients with chronic pain and want to learn how to safely address opioid prescribing.
  • The WA State Department of Health Pain Management Resources website includes pain rules, dosage calculator, clinical tools, and CME training opportunities.
  • The American Medical Association also offers CME courses and webinars on safe opioid prescribing.

Prescription Monitoring Program (PMP)

PMPThe WA State Department of Health Prescription Monitoring Program (sometimes called Prescription Review) is a centralized online database that holds controlled substance prescription information for all patients across the state. Prescribers are able to review their patients’ prescription history information before they prescribe or dispense drugs. This allows them to look for duplicate prescribing, possible misuse, drug interactions and other potential concerns.

More information and factsheets on program rules, registration, use, and reports are available on the Prescription Monitoring Program website.

 

Naloxone co-prescribing   nlxscript

Any health care provider with prescriptive authority in Washington State may prescribe take-home naloxone to anyone at risk for having or witnessing an opioid overdose. In WA State, the Agency Medical Directors Group recommends co-prescribing naloxone for patients in its 2015 Interagency Guideline on Prescribing Opioids for Pain.

sdph

The San Francisco Department of Public Health’s clinicians’ guide Naloxone for Opioid Safety includes tips for patient conversations and patient inclusion criteria.

 

 

The American Medical Association, the American Public Health Association, and the American Pharmacists Association have all endorsed policies to expand availability of take-home naloxone:

prescribetoprevent_smallPrescribe To Prevent is a comprehensive resource on integrating naloxone prescribing into your health care practice. Includes patient education videos, fact sheets, prescribing information, and other materials.

 

EDsignNaloxone in emergency departments

Several emergency departments in WA State are also implementing take-home naloxone programs for patients being seen for opioid overdose.

These resources are useful for emergency department clinicians and administrators interested in naloxone models:
pdficon (2) Naloxone Distribution: Key Considerations/Implementation Strategies (ACEP)
pdficon (2) Sample naloxone protocol from Harborview Medical Center Emergency Department

 

Opioid use disorder among patients

Health care professionals across multiple areas of clinical practice encounter patients with problematic misuse of opioids. In response, more practitioners are actively screening patients for opioid use disorder, referring them for appropriate care, and in some cases, becoming licensed to provide medication-assisted treatment within their scope of practice.

The WA State Medical Association Opioid Clinical Guidance includes a comprehensive list of resources for clinicians on screening, referring and treating patients for opioid use disorder, including:

  • webinars and CME on opioid addiction treatment
  • treatment guidelines and quality practice standards
  • becoming a licensed buprenorphine provider

Screening and diagnosis

Screening patients for problematic opioid use is the first step in diagnosing and treating opioid use disorder. Opioid use disorder is defined by the DSM-5 as “A problematic pattern of opioid use leading to clinically significant impairment or distress” evaluated against 11 diagnostic criteria.     WASBIRT

SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. SBIRT is a tool to universally screen and identify patients with mild to severe substance use disorders, including opioid use disorder. The WA SBIRT Primary Care Integration website has more information on SBIRT including clinical tools, forms, training and reimbursement for SBIRT activities.

Treatment

Medication-assisted treatment (MAT) is an evidence-based approach to treating opioid use disorder that combines the use of FDA-approved medications with behavioral therapies. It is widely endorsed by addiction medicine and substance use treatment experts as the current standard of care for patients with opioid use disorder.

To learn more about MAT:

For physicians who wish to prescribe and dispense buprenorphine to treat opioid use disorder, SAMHSA’s buprenorphine website has information on DEA-waiver qualifications, training, federal practice regulations and a national buprenorphine provider locator tool.

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