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Hospices: 3 Tips on Better Management
of Opioid use in Palliative Patients
by Dr. Ayk Dzhragatspanyan
CEO, Dr. Ike’s PharmaCare
As a Hospice professional you know that hospice patients often suffer from debilitating pain and one method of treating that pain is through the use of opioids that may also lead to potential drug abuse. Dr. Ike’s PharmaCare is a Long-Term Care Pharmacy specializing in medication management for Hospice Agencies and other types of LTC facilities.
The opioid “crisis” as it is often described in the news has caught national attention and the ear of the POTUS. In a recent speech, President Trump mentioned that a focus of the White House is to see the number of opioid prescriptions cut by one-third within three years while expanding patient’s access to proven treatments and recovery programs. You can read more about this topic in the article “How the White House is tackling the opioid epidemic” published by Kaitlyn Schallhorn (@K_Schallhorn) for Fox News. http://fxn.ws/2FY7Cgd
Hospice patients get tremendous benefits from appropriate prescribing of opioids. The involvement of the family often complicates the treatment algorithm. In this setting, opioids are sometimes abused because so many individuals come in contact with the medication. Hospice Physicians may go as far as recommending urine drug screening tests which can tell if a patient is not taking the prescribed drugs, suggesting the possibility of diversion to the street. You can read more on this topic in the article “Hospice and Opioids: Finding a Safe Balance” published by Larry Beresford (@larryberesford) in The Lancet USA Blog. http://bit.ly/2u1tENu
Drawing on these two articles and our years of experience in this space, I can recommend 3 actions you, the Hospice agency, can take to reduce the probability of opiate misuse by your patients:
Perform CURES check - upon admission ask the pharmacy to do a CURES check on the patient. Should be done on 100% of patients on opiates to prevent abuse. The CURES data-base checks for all the narcotic use for the patient and the pharmacist can identify quickly if the patient is using multiple pharmacies, multiple MD's or any other 'red flags'
Identify drug-to-drug interactions - be careful and watch for dangerous combinations such as opiates (oxycodone, hydrocodone) + Soma (carisoprodol) + benzodiazepine (Xanax, Ativan, Valium), also known as 'holy trinity'. This is a common combination of abuse and results in most accidental overdose cases.
Flag dosage/pill color - watch for patients asking for specific strength and color of pills, such as 'blue oxycodone 30', 'yellow Norco 10', or 'pink Promethazine with codeine'. These pills have high street value.
Starting today, hospice agencies along with their pharmacy partners should perform CURES checks, monitor drug-to-drug interactions and keep an eye out for suspicious “highly abused” forms of opioids to do their part in offering the safest treatment choices for patients.
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