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Narcotic
Analgesia
July 1999
Patients who require narcotic analgesia for pain management
pose a unique risk for the prescribing physician. Fortunately,
this group also presents an opportunity for physicians to hone their informed consent
skills. Narcotic dispensing is the most
frequent subject of investigation by state medical boards.
Patients with chronic pain and those who exhibit drug-seeking behaviors are often
frustrating to the treating physician. Most
physicians simply do not know what to do with such patients, who are often labeled as
"drug seeking." This label may
interfere with or cloud a physician's independent medical judgment related to the
patient's health care needs. The informed
consent process is a powerful risk management tool. It
can be used as a framework within which physicians can effectively treat patients who
require narcotic analgesia.
Upon
initiation of narcotic therapy and upon periodic re-evaluation of ongoing narcotic
analgesia, use the following four-step informed consent process. Be sure to document your conversation in the
medical record.
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TREATMENT - Explain to the
patient your recommended treatment (narcotic analgesia) and why it was chosen. For some patients, the recommended treatment may
be to discontinue use of the narcotic and try a non-narcotic analgesic. Or, if symptoms are consistent with drug
addiction, the recommended treatment might be rehabilitation.
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ALTERNATIVES - Educate the patient on alternatives available to them. For example, if the patient has a pulled muscle,
alternative treatments might include non-narcotic analgesia combined with physical
therapy. If a patient has drug-seeking
behaviors, it is especially critical to explore alternative treatments. Do not continue to prescribe the same treatment
regime if the patient experiences little or no improvement in symptoms.
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RISKS -
Discuss the risks of the recommended treatment. Be certain the patient understands that narcotics
are habit forming and one of the risks of narcotic use is addiction.
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QUESTIONS -
Finish the informed consent process by asking if there are
any questions.
Keep the
following tips in mind:
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Because of the risk of addiction, always consider non-narcotic
treatment when making an initial diagnosis and upon periodic re-evaluation.
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If a patient begins to exhibit drug-seeking behaviors,
re-evaluate the dosage to determine if the patient has developed a tolerance to the
medication.
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Signs of physical dependence or tolerance do not necessarily
indicate addiction in the patient who exhibits drug-seeking behaviors.
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Past or present addiction to any drug or alcohol is a risk
factor for narcotic addiction. Thorough
assessment before prescribing a narcotic can help patients avoid narcotic addiction.
Remember: It is important to treat all patients for whom you
prescribe narcotics consistently. This will
enhance your ability to provide the best possible health care and avoid distracting
patient labels.
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