Psychiatric Care and Its Role in Managing Opioids

When opioids are to be used to treat psychiatric or pain disorders, the practitioners must educate themselves regarding the neuroscience of opioids so that they can competently prescribe these medications for use in psychiatric and chronic pain syndromes. At a minimum, the treating healthcare professional should be aware of some of the more common medical side effects of the opioids.

The safe and effective use of opioids for improving health and easing suffering of psychiatric and/or pain management patients is inextricably intertwined with the management of risk, and the careful practitioner will, at all times, consider the risk of abuse/misuse with each and every chronic pain and/or psychiatric patient.

Abuse monitoring can only be accomplished by frequent contact with the patient. In these days of economic hardship and high fuel costs, bimonthly and even monthly visits may be very difficult for most patients, and not just in rural areas. In high-risk patients, the hardship of frequent visits such as these may still be required. However, for those patients who have proven their trustworthiness/responsibility regarding their opioid medications, comprehensive visits every month, two months or rarely three months, are prudent.

Documentation of the patient’s psychiatric and/or pain responses to the prescribed opioid medications is a must. This takes significant face to face time to ascertain the patient’s mood and cognitive responses to their opioid medications. The ultimate treatment goal is mood and cognitive stabilization.

One solution that can help stem opioid abuse is electronic prescribing of controlled substances. Transmitting prescriptions electronically is a way for doctors to directly communicate with pharmacies — rather than handing patients a paper form ripped from a pad. E-prescribing facilitates detection of doctor shopping. In addition, once a prescription for a chronic condition has been prescribed, refills should require less effort by doctors and patients.

Better tracking and control of opioid drugs will help keep potential abusers away from prescription narcotics. Several states have already taken steps to implement e-prescribing to avoid opioid abuse. Many physicians and most pharmacies are already equipped to transmit or receive prescriptions electronically.