What is Opioid Stewardship?
Opioid stewardship describes the steps taken by a community to monitor, evaluate, and improve use of opioids for the purpose of supporting and protecting human life.
While opioid stewardship is everyone’s responsibility, it looks a little different for each community member.
For providers, it means staying up-to-date on the current body of evidence behind best prescribing practices and communicating this information to patients. For patients, it means practicing safe handling, storage, and disposal of opioids, as well as considering alternative pain-management practices recommended by providers.
Opioid stewardship is a necessary response to the epidemic of opioid addiction in the United States. Through opioid stewardship, our providers ensure patients access to safe and effective chronic pain treatment while reducing risk of addiction, overdose, and death.
Advanced Pain Care seeks to help patients overcome addiction without the fear of a life of chronic pain. Our expert care team will work with you to develop the treatment plan that best meets your needs and lifestyle.
Opioid Stewardship Guidelines
The CDC Guideline addresses patient-centered clinical practices for using opioids to manage chronic pain in a way that facilitates the highest quality of life. The three main focuses of opioid stewardship from a provider perspective are as follows:
- Determine when to initiate or continue opioid therapy for chronic pain management, including selecting non-pharmacologic therapy/non-opioid pharmacologic therapy as appropriate
- Establish treatment goals based on a discussion of risks and benefits of therapy, including identifying type, dosage, duration, follow-up, and discontinuation of treatment
- Assess risk and address harms of opioid use, including mitigation of patient risk through the prescription drug monitoring program (PDMP) data, use of urine drug testing, considerations for co-prescribing benzodiazepines, and arrangements for treating opioid use disorder if necessary
Advanced Pain Care’s Opioid Stewardship Offerings
Advanced Pain Care offers a variety of services and offerings to help you and your provider develop the most effective, least limiting plan of care possible:
- Reassessment of the risks and benefits of chronic opioid therapy.
- Treatment of hyperalgesia (the increased sensitivity to pain that can occur with long-term use of prescription opioids)
- Treatment of tolerance (the inability to achieve adequate pain control that can develop with increasing doses of prescription opioids)
- Minimizing risk of overdose by addressing issues of co-prescription of sedative medication in combination with opiates
- Addressing inconsistent laboratory results found during pain management monitoring
- Emphasizing non-opioid modalities for chronic pain
- Tapered high-dose opioid regimens
- Rotation to safer and less restrictive opioid regimens
- Managing pain and anxiety associated with symptoms of withdrawal from opioids
- Treatment of prescription medication dependence
- Treatment of opioid use disorder
- Treatment of other substance use disorders including: stimulants, alcohol, benzodiazepines, and nicotine
Learn More About Addiction and Treatment
- Yale clinicians pilot new technique to reduce opioid risk in pain treatment.
- State of Addiction: Drug treatment relieves symptoms of withdrawal from opioids.
- Washington Post: Our Dangerous Fear of Pain.
- Safer Opioids: A Well Kept Secret for Chronic Pain.
- Using Buprenorphine for Chronic Pain Management.
- Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion
Our Opioid Stewarship Specialists
Advanced Pain Care’s specialists bring extensive clinical and research experience to our team of expert pain care physicians and provides our patients with the highest quality of care.
Q: Can a rheumatologist prescribe opioids?
A: Approximately 40% of rheumatologists in the United States prescribe various opioids to patients with rheumatoid arthritis (or RA), fibromyalgia, osteoarthritis, and other chronic pain and non-pain cancer conditions.
To help rheumatologists effectively manage and prescribe opioids while preventing the risk of addiction, drug abuse, and death, several international recommendations and guidelines have been developed. Per the American Society of Interventional Pain Physicians, all rheumatologists must adhere to certain principles and specific rules when prescribing opioid medications. It is imperative they begin treatment with an accurate evaluation and assessment of the pain and its origin which informs (and clearly defines) the objectives of the treatment (such as relieving pain, increasing functionality, and/or improving the quality of life). This is the guide for decisions involving the type, dosage and duration of the opioid medication they feel is best suited for overall care and well-being of their patient.
Advanced Pain Care runs a comprehensive opioid stewardship program to support their doctors and patients in effectively implementing and managing opioid medications responsibly on a case-by-case basis for the treatment and management of pain. Advanced Pain Care offers multi-modal specialties to treat pain at one location (Pain Management, Rheumatology, Orthopedics and Neurosurgery), and provides the latest pain management techniques and treatments so you can get back to feeling your best.
Q: Are opioids used for arthritis?
A: Opioids are rarely used in the treatment of arthritis, and only prescribed in cases of severe, chronic pain. Most pain medications are reserved to manage pain after a surgery or acute injury, and opioid medications to treat arthritis are only considered if previous treatments are not effective in providing pain relief.
Prescribing opioids for patients with arthritis requires caution and all safety guidelines must be followed. Prescription opioid medications pose the risk of drug abuse, addiction, and can pose serious health risks for patients that include:
- Heart problems
- Disturbances in breathing
- Mental confusion and brain fog
In some cases, opioid medications may actually increase the pain being experienced by someone with arthritis. In other cases, patients may develop a tolerance to prescription pain medication. Safer options do exist for the effective treatment and management of arthritis, so the use of prescription opioids for this condition should only be considered as an option if previous treatments fail to reduce the pain.
Q: Are opioids used for pain management?
A: Opioids are usually only prescribed in cases where pain management is the main goal. In cases of short-term pain caused by acute injuries, accidents, or surgeries, pain management specialists at Advanced Pain Care will often briefly prescribe opioids to help alleviate pain from the event. Opioids are also prescribed in chronic pain conditions, such as cancer pain.
Opioids are very powerful drugs and there is always the risk of opioid addiction, abuse, and in some cases, death. Due to the underlying risk, doctors are guided by a specific framework when prescribing opioids for pain management. These guidelines include specifics on when opioid medications can be prescribed, at what dosage, and the duration.
Per the Centers for Disease Control and Prevention (CDC), the use of opioids for over three days may expose the patient to the chances of addiction so the intervention of pain management specialists plays a crucial role in this transition from opioid medication to non-opioid pain medications for patients.
Common drugs used for relieving and managing pain that do not contain opioids are:
- Anticonvulsants (anti-seizure medications)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Lidocaine patches
Advanced Pain Care is a leading pain management practice that operates a comprehensive opioid stewardship program to help manage and regulate the usage of opioids in pain care treatment. To learn more about this program or to set up a same or next day appointment, call 512.244.4272.