West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

What is West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion?

Using and abusing opioids for pain that is either sudden or lasts a long time is a major issue in both the United States and West Virginia. Drug overdoses related to illegal opioids are increasing rapidly in the US, with West Virginia seeing the highest rate, amounting to nearly 41.5 deaths per 100,000 people in 2015.

Over a quarter of US citizens suffer from chronic pain, a condition where pain lasts longer than three months. This means it’s a common reason people visit out-patient clinics and emergency departments. Dealing with sudden and ongoing pain poorly, and the potential for becoming reliant on opioids when treated, can lead to serious health problems and even death. That’s why it’s crucial for healthcare providers to understand how to treat patients with chronic pain.

In fact, one in five patients visit their primary healthcare provider with a complaint related to pain. In terms of figures, the United States spends more than 100 billion dollars a year on healthcare costs related to managing pain and opioid dependence, which is more than the costs of treating cancer, diabetes, and heart diseases combined.

Effects of how a patient’s ongoing pain is managed can significantly impact a patient’s quality of life in the long term. Multiple sources can be the cause of chronic pain. A combination of drugs and non-drug treatment methods can greatly reduce pain compared to just a single treatment. Treatment should escalate in a gradual approach. Notably, feelings of sadness and anxiousness are common in patients with chronic pain. Moreover, patients with chronic pain are at higher risk of suicide that might affect every aspect of their lives, making it critical for them to receive the right diagnosis and management.

On the downside, most medical schools and training programs in the US fail to teach about pain management effectively. Addressing this issue, Centers for Disease Control and Prevention encourages medical schools to include their guidelines on prescribing opioids for chronic pain in their curriculum.

Appropriate opioid prescribing means giving sufficient opioid medication by regularly assessing, planning treatment, and monitoring to control pain effectively while preventing addiction, abuse, overdose, and misuse of prescription. This means healthcare providers need to understand what appropriate opioid prescribing is, assessment, the potential for addiction and abuse, and potential psychological problems.

The American Society of Addiction Medicine defines addiction as a chronic disease that is treatable and involves a combination of elements including genetic factors, life experiences, and mental functions. People who are addicted to opioids usually exhibit behaviors that become uncontrollable and may result in dangerous outcomes. Five characteristics common to addiction are craving, emotional dysfunction, failure to recognize significant problems, inability to consistently abstain, and impairing behavioral control.

Unfortunately, most healthcare provider’s understanding of addiction is often misleading due to variations in views. Same issues are prevalent in lawmakers and law enforcement officers who should be informed about it. Moreover, misunderstanding addiction also affects those who pay for the costs of evaluating and treating addiction. A considerable lack of education and the use of outdated words continue to contribute to society’s difficulty in effectively dealing with the challenges of addiction.

In the past, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders used different terms for “addiction”, “substance abuse”, and “substance dependence”. The use of different words caused confusion and resulted in under-treatment of pain. To rectify this, the manual has since eliminated these terms and now uses the term “substance use disorder”.

However, there are several challenges in managing pain, like underprescribing and overprescribing opioids. These problems are particularly seen in patients with chronic pain and have caused patients to suffer from inadequately treated pain, while at the same time, leading to an increase in opioid abuse, addiction, and overdose. Consequently, healthcare providers fail to prescribe appropriate and effective opioids to patients with chronic pain. They often prescribe poorly because they were not properly educated and informed about opioid prescription. Oftentimes, patients with chronic pain who are prescribed opioids develop tolerance to them, along with psychological, behavioral, and emotional issues, including anxiousness and depression related to under or overprescribing opioids.

Doctors prescribing opioids face challenges involving medical negligence in either failure to provide adequate pain control or risk of losing their license or even criminal charges if perceived as involved in drug diversion or misuse. All healthcare providers prescribing opioids need additional education and training to provide the best patient outcomes and navigate the social and legal issues associated with under and over-prescribing opioids.

Major gaps exist in knowledge regarding appropriate and inappropriate opioid prescribing, including lacks in understanding current research, laws, and accurate prescribing practices. There’s a wide misunderstanding about addiction and opioid addiction risk groups, the difference between prescription and non-prescription opioid addiction, and the difference between dependency and addiction. As a result of historical lack of understanding, poor societal education, and inconsistent laws, opioid prescription has led to major societal difficulties that can only be resolved through extensive education and training.

Here are some terms you may need to know:
– Abuse: Is the misuse of opioids for a purpose other than pain relief.
– Addiction: Is the uncontrollable pursuit of a chemical substance for relief or reward.
– Dependence: Is the use of a drug that causes a withdrawal syndrome when stopped or reduced.
– Diversion: Is the transferring of a controlled substance from an authorized person’s use to an unauthorized person for distribution or possession.
– Misuse: Is the use of a medication in a manner different from how it was prescribed.
– Pseudo-addiction: Is drug-seeking behavior similar to opioid use disorder driven by a need for pain relief. It is resolved with pain control.
– Tolerance: Is the adaptation to the effect of a drug.

What Causes West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion?

Many people dealing with long-lasting or chronic pain often report more than one type of pain. For example, someone may have ongoing back pain as well as a condition called fibromyalgia. It is also not uncommon for individuals experiencing chronic pain to have mood disorders such as major depression or generalized anxiety disorder. In fact, over 67% of patients with constant pain also experience a mental health disorder.

Let’s break down the various types of pain someone might experience:

1. Neuropathic Pain – This involves damage or malfunction in the nerves. Examples are post-herpetic neuralgia (lingering pain after a shingles outbreak) and diabetic neuropathy (nerve damage caused by high blood sugar from diabetes). Central neuropathic pain involves nerve damage in the brain or spinal cord and might happen after a stroke.

2. Nociceptive Pain – This is caused by physical injury to the body like burns, bruises, or broken bones.

3. Musculoskeletal Pain – This refers to discomfort in the muscles or bones, such as back pain or what’s called myofascial pain, which involves pain in the muscles or the sheaths covering them.

4. Inflammatory Pain – This is due to issues with the immune system, such as rheumatoid arthritis, or infections.

5. Psychogenic Pain – This is pain linked to psychological factors. For example, emotional stress may sometimes cause physical symptoms like headaches or stomach pain.

6. Mechanical Pain – This is associated with physical growths in the body, such as tumors.

When it comes to dealing with pain, opioid treatment is often used but carries significant risk and complications. Opioid misuse can result out of physical, social, and financial issues.

Medical and Social

During the past two decades, healthcare providers started treating pain more aggressively. Pain was considered so important to observe that it was known as the “5th vital sign”, and doctors who didn’t treat pain effectively could have faced legal and professional complaints. During this period, a drug called oxycodone was introduced that was claimed to have a low risk of addiction. Patients and doctors started to perceive prescription opioids as a safer option than street drugs. This shift resulted in a major increase in the use of prescription opioids.

Economic

The use of opioids has risen due to efforts like direct advertising to consumers; sales pitches to doctors and pharmacists; and illegal production and distribution of these drugs. Because of the opportunity for huge profits, some providers started running “pill mills,” prescribing large amounts of opioids with little justification. As access to these pills has tapered off, heroin use has risen.

Manufacturers of opioids have been taken to court by people and governments for their role in promoting opioid use. Purdue Pharma, for example, was found responsible for promoting a long-acting form of oxycodone.

Over-prescription by healthcare providers for chronic pain that goes beyond recommended guidelines has increased opioid misuse and the health issues and deaths related to it.

Sometimes, doctors challenge pharmacists who question prescriptions that seem unreasonable. However, pharmacists can use tools like state opioid databases to monitor the use and prescription of these drugs and express concerns if necessary. Working together and sharing information is often encouraged to provide safe care to patients.

Risk Factors and Frequency for West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

Chronic pain is prevalent in the U.S., affecting over 100 million people. Of these, approximately 50 million experience severe chronic pain that impacts their daily life. Different types of chronic pain include regional pain (11.1% of patients), back pain (10.1%), leg and foot pain (7.1%), arm and hand pain (4.1%), and headaches (3.5%). There’s also a small proportion (3.6%) having more widespread pain.

Although elderly patients receive up to 25% fewer pain medications than the average population, chronic pain significantly affects the economy, costing over $600 billion each year in productivity loss and medical treatment. Over a lifetime, more than half of all adults will experience chronic pain, with over 40% expressing that their pain is unmanaged, and more than 10% suffering from long-term disabling pain. Unfortunately, chronic pain has also been linked to suicidal tendencies.

When it comes to opioids, these are often used to manage chronic pain. They are either synthetically created or derived from the opium poppy. They work on three types of receptors in the body: mu, kappa, and delta, each of which has different effects. The use of opioids was previously limited to treating chronic cancer pain, but it increased during the 1990s when healthcare providers were encouraged to treat pain more aggressively. Currently, the U.S. is the biggest consumer of opioids worldwide, accounting for more than 80% of the global use.

Prescription drug misuse, particularly opioids like hydrocodone and oxycodone, has affected West Virginia severely. Although medical professionals have made efforts to reduce inappropriate prescription of opioids, their diversion has led to an increase in the use of illicit drugs like heroin and fentanyl. Overdoses due to these substances have risen sharply, causing West Virginia to suffer the highest drug overdose rate in the U.S.

Efforts to educate and make legal changes resulted in a decline in the number of opioid prescriptions in West Virginia. Despite the decrease, there’s a rise in the use of illicit opioids due to fewer legal prescriptions, and drug overdose deaths exceed deaths from auto accidents. Illicit opioid use raises significant issues, causing societal troubles, mental health problems, medical issues, and death.

Signs and Symptoms of West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

When understanding a patient’s history of pain, it’s important to know details such as when the pain started, the type of pain they feel, if there was an injury that caused the pain, where it’s located, if the pain moves, and how severe it is. Other factors needing consideration include what makes it better or worse, how often it happens, and if there’s sudden sharp pain. A scale from 0 to 10 is commonly used to measure pain severity. It’s also necessary to check for other symptoms, like muscle spasms, temperature changes, limited movement, stiffness, weakness, sensory changes, and changes in the skin, hair, or nails.

Apart from these, it’s crucial to understand how pain affects a person’s daily life, such as their relationships, hobbies, mood, sleep, physical activities, work, and basic tasks like eating and dressing. Older adults often find it tough to self-report their pain, and sometimes they might express it differently, which makes diagnosing pain more challenging.

Among the various methods used to understand a patient’s pain history, some common abbreviations employed are COLDERAS and OLDCARTS. These summarise factors like the character, onset, location, duration, relieving factors, worsening symptoms, any radiation of pain, associated symptoms, and severity of illness. Additionally, PQRST is used to understand what provokes or relieves the pain, its quality, if and where it radiates, severity and when it usually occurs.

Several tools help assess pain and its severity, including the ‘Pain, Enjoyment, General Activity’ (PEG) tool which focuses on how pain affects a person’s function and quality of life. Another tool used is the Four-Item Patient Health Questionnaire or PHQ-4, is used to screen for symptoms of depression and anxiety. In cases where patients may not be able to communicate their pain, methods like behavioural observation scales or visual diagrams can be employed. Other tools, such as the Pediatric Pain Questionnaire or Adolescent and Pediatric Pain Tool, help understand the location of pain for children.

Lastly, people who cannot communicate, like nonverbal children with neurological impairment, are challenging to assess, and caregivers often help determine changes in the patient’s behaviour. In such scenarios, tools like the Revised Face, Legs, Activity, Cry, Consolability (r-FLACC) scale can be particularly useful.

Finally, a detailed physical examination which includes musculoskeletal, neurological, and psychiatric tests, as well as a specific assessment of the pain area, should be conducted.

Testing for West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

If you are dealing with chronic pain, your doctor might not order standard blood tests or imaging unless they suspect a specific cause for your pain. Sometimes, they might also ask for a urine test to check if you are taking your medication correctly and are not using any illegal drugs.

Interestingly, having mental health issues can sometimes worsen the experience of pain. Conditions like major depression can make pain worse and delay the diagnosis of pain disorders. This is because symptoms such as fatigue, changes in sleep, loss of appetite, and decreased activity can escalate pain over time. Therefore, it’s important to screen for depression in patients dealing with chronic pain. Tools like the Minnesota Multiphasic Personality Inventory-II or Beck’s Depression Scale are often used for this.

When chronic pain is being treated with opioids, it’s crucial to assess the risk of developing unhealthy responses to these drugs, like addiction. Doctors determine this risk level based on various factors including a patient’s past history, physical exams, family members’ accounts, and other screening tools. Patients are categorized as low-risk, moderate-risk, or high-risk, with each category requiring different levels of monitoring and care.

Specific criteria are evaluated for each risk level. For example, low-risk patients may have localized physical symptoms, no history of substance abuse, mild medical or psychological issues, and a willingness to participate in multimodal therapy. In contrast, high-risk patients might have significant widespread pain, exhibit drug-related behavior, have a family history of addiction, and be unwilling to participate in multimodal therapy.

When prescribing opioids, not only is it essential for doctors to understand the patient’s medical history and pain profile, but they must also weigh all potential risks, such as abuse, adverse reactions, overdose, and physical dependency. If a patient’s history indicates potential issues, like past substance abuse, the doctor will likely consult with a psychiatrist or an addiction specialist before prescribing opioids.

Doctors also use different tools to assess the level of monitoring needed for the treatment plan. These tools include the Brief Intervention Tool, CAGE questionnaire, Current Opioid Misuse Measure, and others. They help identify possible signs of opioid addiction or abuse, and can categorize the patient into low, medium, or high levels of risk based on their responses.

Before prescribing opioids, there are guidelines for documentation to ensure the quality of care and for legal protection. The doctor will record details about the dosage, the understanding of the risks and benefits of the medication, plans for storage and disposal of unused opioids, and the patient’s willingness to participate in the treatment plan. As part of this process, doctors will also evaluate any ‘red flags’ that may indicate potential issues, such as early prescription refills, multiple prescribers, or unrealistic expectations from the patient.

As part of treatment, the Prescription Drug Monitoring Programs (PDMPs) in various degrees are utilized in every state to decrease drug abusers’ access to opioids. Despite some limitations, they help monitor outpatient prescriptions, reduce “doctor shopping,” and encourage teamwork between prescribers and pharmacists. In the future, the requirements for these systems are expected to expand for better tracking and control.

Treatment Options for West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

Healthcare professionals treat chronic pain by applying best practices in prescribing pain relief like opioids, carrying out pain assessments, and evaluating pain management techniques. Both drug-related and non-drug-related options should be considered. Opioids may be suggested for those with chronic moderate-to-severe pain who have not gotten adequate relief from non-opioid therapies. But, the treatment should begin as a trial and not a fixed course of treatment. The Centers for Disease Control and Prevention (CDC) has also issued guidelines on how and when to use opioids for chronic pain.

If initial treatments do not provide relief from severe or incapacitating pain, the patient might be referred to a pain management specialist. This is especially recommended if the patient has pain in multiple locations, has another co-existing mental health disorder, or requires a combination of treatments. Treating both the pain and any existing mental health disorder can drastically help to reduce symptoms.

There are many choices for drugs to manage chronic pain. These include non-opioid painkillers like NSAIDs (like ibuprofen and aspirin), acetaminophen, and others. Some drugs like tramadol, opioids, and some antiepileptic drugs can also be used. Antidepressants, muscle relaxers, and various other drugs may also be considered. Every patient’s response to treatment can be different, which is why most treatments are done step-by-step to reduce the negative effects of opioid painkillers.

For chronic back pain or osteoarthritis, the first-line treatment would typically be acetaminophen or an NSAID. These are effective but not suggested for patients with a history of heart disease, kidney disease, or peptic ulcers. If these two options don’t work well enough, opioid analgesic treatment could be considered, but with caution due to potential negative effects.

Opioids are generally considered as a secondary option and not the first line of treatment. However, for some people with severe and persistent pain, they may be the best option for pain management. Opioid therapy should only be given when other pain medications haven’t relieved the pain and when the pain is severely impacting the patient’s quality of life. Opioids can lead to side-effects like constipation, dependence, and a heightened sensitivity to pain. The side effects increase as the dosage increases.

All types of pain are not the same and do not respond to the same treatments. For example, chronic musculoskeletal back pain and severe diabetic neuropathy will need different treatments. Therefore, a combination of multiple drugs is often needed to manage neuropathic pain.

For certain types of pain, non-drug treatments play a significant role. This includes heat and cold therapy, cognitive behavioral therapy, relaxation therapy, biofeedback, group counseling, and more. There are also interventional techniques to manage chronic pain, such as spinal cord stimulation, epidural steroid injections, radiofrequency nerve ablations, and others.

However, non-drug related treatments may not be effective on their own and may require additional options. For some patients who tried all other options without success, implantable intrathecal delivery systems are an option. Patients with chronic pain also have the option of a spinal cord stimulator if other methods have failed for them. Most commonly, these devices are used after a back surgery doesn’t provide expected relief. They can also be used for other causes of chronic pain. Studies show that they can reduce pain by 50% compared to medical therapy alone.

What else can West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion be?

Pain is a signal that something might be wrong in the body, not a specific disease or condition itself. When a patient reports chronic pain, doctors need to figure out what underlying health issues could be causing this pain. To do this, they make a list of possible causes to test and rule out, which is known as a differential diagnosis. This helps them identify the most effective treatment.

For example, if a patient is experiencing nerve pain, it’s important to figure out if it’s coming from a problem in the brain and spinal cord, or if it’s due to a problem in the nerves throughout the body. Another example is knee pain – doctors need to determine if it could be due to severe osteoarthritis, which may require a knee replacement surgery or injections. However, if the pain is because of other conditions like rheumatoid arthritis, an infection, gout, pseudogout, or a knee meniscal injury, they would need different kinds of treatments.

When it comes to chronic, generalized pain that affects the whole body, the differential diagnosis might include:

• People who develop increased sensitivity to pain due to prolonged use of opioids
• Patients with depression, other mental health disorders or sleep issues like insomnia
• Autoimmune diseases (like lupus or psoriatic arthritis)
• Fibromyalgia
• Central pain syndromes

Moreover, there are main four kinds of pain: caused by nerve damage (neuropathic), related to the muscles or skeleton (musculoskeletal), due to physical forces (mechanical), and related to inflammation. If any of these types of pain persist and aren’t treated effectively, it could lead to chronic pain. Over time, chronic pain itself can become the primary health issue as it changes the body’s neurochemistry. That’s why it’s important to treat acute (short-term) and subacute (somewhat long-term) pain before it becomes chronic (long-lasting).

What to expect with West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

Current treatments for chronic pain can help reduce a patient’s pain by about 30%. This decrease can significantly improve the patient’s day-to-day tasks and their overall happiness. However, in the long term, patients suffering from chronic pain may find that their ability to perform tasks and their quality of life decrease. If patients also have a psychiatric illness such as depression or anxiety, treating this can help improve their chronic pain. Chronic pain can lead to a higher chance of experiencing other long-term diseases and obesity. Patients with chronic pain are also much more likely to take their own lives compared to those without chronic pain.

A treatment method known as spinal cord stimulation unfortunately only provides enough pain relief for about half of the patients who try it. Furthermore, a significant number of these patients (between 20 to 40 percent) may become tolerant to this procedure, causing it to become less effective over time. This is also true for patients who rely on opioids (a type of strong painkiller) to manage chronic pain. As the body becomes used to the medicine, the patient’s risk of health problems and death increase.

In the end, the best way to manage chronic pain is to prevent it in the first place. If acute (sudden and severe) and subacute (somewhat severe but not chronic) pain are treated properly, then it can stop the pain from becoming chronic (long-term) and greatly minimize its impact on the patient’s quality of life.

Possible Complications When Diagnosed with West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

Chronic pain can significantly deteriorate one’s quality of life, resulting in reduced productivity, lost income, worsening of existing chronic illnesses, and mental health issues like depression, anxiety, and substance abuse. Moreover, those suffering from chronic pain have higher chances of suicide.

Various medications used to cure chronic pain come with potential risks and side effects, as well as possible complications.

Acetaminophen is commonly used to manage chronic pain and is usually consumed alone or in combination with an opioid. However, this medication can harm the liver, especially when consumed in quantities more than four grams per day. It is a common cause of acute liver failure in the U.S. Even at therapeutic doses, it can harm people with chronic liver diseases.

Commonly-used supplementary medications such as gabapentin or pregabalin can cause side effects like drowsiness, swelling, mood changes, confusion, and respiratory depression, especially in older patients requiring additional painkillers. These medications must be used with caution in elderly patients with painful diabetic neuropathy. A combination of gabapentin or pregabalin with opioid painkillers has been found to increase the death rate among patients.

Duloxetine can cause mood changes, headaches, nausea, etc., and should be avoided in patients with kidney or liver disease.

Opioids therapy can lead to addiction, overdose, respiratory compromise, and heightened sensitivity to painful stimuli. Long-term use of opioids can lead to constipation, dependence, nausea, indigestion, irregular heartbeats, and opioid-induced hormonal imbalance resulting in menstrual irregularities, impotence, enlarged breast in males, decreased energy, and libido. An increase in daily morphine equivalents increases the chances of opioid overdose.

Spinal cord stimulators have a high complication rate ranging from 5 to 40%. Issues like lead migration causing inadequate pain relief and requiring revision and anchoring are common, especially in the neck region of the spinal cord. Also, lead fracture and seromas common in the spinal cord stimulator can occur requiring surgical intervention and drainage.

The risk of infection after a spinal cord stimulator procedure lies between 2.5 to 12 percent. The severe infectious complication could be a spinal cord abscess. In up to 70% of patients, a dural puncture can cause a post-dural headache. The most significant adverse to spinal cord stimulator placement would be a spinal epidural hematoma—requiring immediate neurological decompression. The incidence of a spinal epidural hematoma is 0.71%.

Drug Diversion and Drug Seeking [67]

Regrettably, some people seek prescribed opioids for addiction or monetary benefits. These prescription opioids may be obtained from a friend or relative, bought from a black market drug dealer, obtained by doctor shopping and acquiring drugs from multiple prescribers, and theft from clinics, hospitals, or pharmacies.

Signs of such behaviors include:

• Aggressive demands for more opioids
• Asking for opioids by name
• Behaviors suggesting opioid use disorder
• Forged prescriptions
• Increased alcohol use
• Increasing medication dose without the provider’s permission
• Injecting oral medications
• Obtaining medications from nonmedical sources
• Obtaining opioids from multiple providers
• Prescription loss or theft
• Reluctance to decrease opioid dosing
• Resisting medication change
• Requesting early refills
• Selling prescriptions
• Sharing or borrowing similar medications
• Stockpiling medications
• Unsanctioned dose escalation
• Using illegal drugs
• Using pain medications to treat other symptoms

Prescribers and dispensers can take several precautions to evade drug diversion, such as communication among providers and pharmacies, educating patients on opioid sharing dangers, encouraging patients to keep opioid medications private, and reporting patient prescribing to the state central database, if available.

If patients are suspected of drug diversion, the providers should inquire about their prescription and illicit drug use, conduct a urine drug screen, perform a thorough examination, count pills, and restrict opioid prescriptions.

If a patient is found to misuse prescribed opioids, the treatment agreement is violated, and the provider may choose to discontinue their services to the patient, ensuring adequate notice and continuity of care. The use of controlled substances or selling them should be reported immediately to the Drug Enforcement Administration, and the patients should be referred to a pain specialist. Any drug diversion activity should be documented and reported to law enforcement.

Preventing West Virginia Opioid Prescribing for Chronic Pain While Avoiding Drug Diversion

Patients and their families can play a vital role in decisions regarding the use of opioid painkillers. Family members often recognize when a patient is feeling depressed or is less able to complete daily tasks. Important questions for the family might include:

* Does the patient plan their day around taking opioid pain medication?
* How often does the patient take their pain medicine?
* Does the patient struggle with problems related to alcohol or other drugs?
* Does the patient avoid being active?
* Does the patient seem depressed?
* Is the patient able to carry out normal activities? 

When a patient is taking opioids, there are several key things they should be aware of:

* They should not drive or operate machinery.
* It’s important not to stop taking opioids suddenly.
* They should not take other substances that might slow down their breathing, such as alcohol or certain types of anxiety or sleep medications.
* If their pain medication isn’t providing enough relief, they should get in touch with their doctor or another professional who prescribed the medication.
* They should discard of opioids properly, usually by flushing them down the toilet or mixing them with cat litter or coffee grounds.
* They must not chew tablets.
* They should never share opioids with friends or family members.
* They should always follow the dosing schedule provided by their prescriber.
* They should only take opioids as prescribed.
* It’s important to have realistic expectations about what the medication can do.

Doctors, pharmacists, and other health professionals need to work together to ensure safe and proper use of opioid medications. Doctors prescribe the medication initially, but pharmacists also have a crucial role in checking that prescriptions are appropriate and legitimate. If there’s a failure to spot potential misuse or abuse, this can lead to problems for the patient and wider society. On the other hand, being too strict can deny patients who genuinely need pain relief. Working together as a team is likely to produce the best results.