it provides specific information to several physicians dealing with addicted patients who also have a mental disorder, but it follows a series of pre-existing public health guidelines.
Theoretical guidelines
The Treatment Improvement Protocols (TIPs), developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), provide general guidelines for physicians trying to evaluate how much risk a patient has for developing problematic opioid use.
The protocol states that for some patients with a history of substance use disorder, the risks associated with opioid use likely overweight the analgesic benefits of the drug. However, the same protocol states that the risk level of opioid use for patients is solely a matter of clinical judgment.
“The reality in a busy emergency room is that doctors want to assess the problem and treat the problem as quickly as they can, so they can keep going and attend to the next patient that comes in,” Ross said. “Unfortunately, even a prescription from the emergency room provider can lead someone down the wrong path.”
Every alternative should be explored before a physician resorts to prescribing opioids, but according to Ross, that’s often not the case. Instead, failed clinical judgment, and overlooking clinical guidelines are what often leads to opioid abuse.
“I am seeing now that a lot of primary care providers don’t even want to touch opioids because there’s so much liability, so they just refer to the pain specialist,” she said. “Often, it takes a long time for a patient to see a specialist so that becomes problematic. Meanwhile, other doctors are just irresponsible. They may be aware of the dangers involved but that’s not at the forefront of their mind when they’re prescribing.”
Mental disorders do not discriminate and opioid abuse impacts all members of society. Responsible prescribing practices, therefore, should be looked at as civic responsibilities by everyone – starting with health care providers.
“Primary care providers need to do more screenings so they can get a better sense of who might be a poor candidate for opioid therapy,” Ross said. “We have guidelines now that can steer health care providers in the right direction. Do they always adhere to those directions? Probably not. Do they even know they exist? They should. There are mandatory courses now for all physicians, such as ‘safe opioid prescribing.’ There’s a real effort to educate healthcare providers because when it comes to prescription drugs, we are the ones who are putting it out there.”
