Marc E. Lynch, DO, medical director, Casa Colina Surgery Center (Chino, Calif.): We have re-examined our policies to make sure we are doing everything possible to provide a safe environment for our patients who do receive opioids. It is ironic that 10 years ago, they enacted the law requiring pain evaluation as a vital sign and punishing those who did not address the needs of the patient. We have now, in a short 10 years, swung over to the other side. We are now more diligent in obtaining urine drug screens, and continue to use the CURES system to try and identify those who do abuse the system and the medications. We have always had strict guidelines in place, and continue to do so. We continue to use opioids as a vital component in the treatment of chronic pain where appropriate, but with that comes strict monitoring, journaling use and urine drug screening. One major concern in California is that with the budgetary issues, the CURES program is now going to be unfunded and soon, not available, which will implore us to be very diligent since we will be losing an important tool.
Ronald DeMeo, MD, MBA, board-certified anesthesiologist and pain-management specialist, Meridian Spine & Interventional Pain Medicine (Coral Gables, Fla.): First of all, we're very judicious in the use of opioids. We probably reduced our prescription rates of these drugs about 90 to 95 percent. We're also selective in the patients we take. We quickly reduce opioid medication to non-opioid as quickly as possible following a successful procedure. The opioids have become a drug of last resort instead of an entry-level modality.
Sudhir Vaidya, MD, director of sports medicine and pain management, Burke Rehabilitation Hospital (White Plains, N.Y.): We have controlled substance contracts. We do not call in opioid prescriptions and we test patients' urine or sputum for compliance and to detect substance abuse. We insist on seeing patients, and we do not mail prescriptions.
Meeru Sathi-Welsch, MD, Long Island Neuroscience Specialists (East Patchogue, N.Y.): I keep close monitoring of my patients that I prescribe narcotics to including checking random urine toxicology screens, checking their pharmacy records and checking their records on the Department of Health Website. Now that pharmacies keep computerized records, it is easier to get information about their opioid use.
Uzma Parvez, MD, Elite Pain Management (Union, N.J.): We have always been very cautious about prescribing opioids, and the screening process for patients with the intention of seeking prescription starts with the staff that make the appointment. I do not prescribe opioids on the first visit. I request records of all the recent treating physicians and pharmacy information.
This is an ongoing series which will feature five pain management physicians' responses to questions about the specialty.
Next week's question is: Do you implement urine drug testing in your practice? What has been your experience with it?
Submit responses to taryn@beckershealthcare.com before Mar. 13.
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