I’m proud to announce this new Clinical Problems in Consultation Psychiatry (CPCP) on managing detoxification from opiates and more from jenny Preinitz, PharmD. I gotta tell you I’m not used to having a pharmacist riding with our team but I’ve always hoped for it. She’s been a tremendous asset this month and I’m sure hoping her preceptor sends more outstanding performers like her our way.
I don’t see a lot of opiate withdrawal so this will be helpful to strengthen my practice. We have a chemical dependency consultation service but they focus on finding outpatient and inpatient treatment resources for patients. It’s the general psychiatry consultation service which gets called about managing detoxification syndromes. Using the Clinical Opiate Withdrawal Scale (COWS) is important. The consulting psychiatrists who wrote the Mass General Handbook of General Hospital Psychiatry say that, when assessing for opiate withdrawal, pay special attention when looking at the patient’s eyes. They say “the eyes never lie,” because they’ll be dilated when the patient is in withdrawal.
What I would really like is for doctors who prescribe opioids and the patients who are at risk for misusing them to keep their eyes open for the signs of opioid use disorder. There’s a paper about it by Manubay and colleagues:
Manubay, J. M., C. Muchow, et al. (2011). “Prescription drug abuse: epidemiology, regulatory issues, chronic pain management with narcotic analgesics.” Primary care 38(1): 71-90, vi.
The epidemic of prescription drug abuse has reached a critical level, which has received national attention. This article provides insight into the epidemiology of prescription drug abuse, explains regulatory issues, and provides guidelines for the assessment and management of pain, particularly with long-term opioid therapy. Using informed consent forms, treatment agreements, and risk documentation tools and regularly monitoring the 4 A’s help to educate patients and guide management based on treatment goals. By using universal precautions, and being aware of aberrant behaviors, physicians may feel more confident in identifying and addressing problematic behaviors. Public Access Article:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328297/, Prescription Drug Abuse: Epidemiology, Regulatory Issues, Chronic Pain Management with Narcotic Analgesics
And hey, Jenny’s presentation is a real eye-opener.
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