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California Pharmacy Board
INTRODUCTION
Healthcare leaders and patient advocates from throughout California met at the Summit on Effective Pain Management: Removing Impediments to Appropriate Prescribing in Los Angeles in 1994 to discuss the effective management of pain. Summit participants concurred that effective pan management, including the use of controlled substance medications, is essential to the health and welfare of Californians experiencing pain. It was also concluded that inappropriate or undertreatment of pain is serious and wide spread.
In response to these findings, the California State Board of Pharmacy is taking a leadership role in promoting the effective management of pain for the state's citizens. The Board's objectives include educating pharmacists on advances in appropriate pain management and taking active roles in providing this therapy. The Board is working to computerize the triplicate prescription program; is encouraging the timely availability of opioids in different healthcare settings such as hospitals, patient's homes and pharmacies; and is encouraging better knowledge and attitudes of patients, the public and other licensed healthcare professionals in the use of pain medications-all with the goal of positively influencing the care of patients in pain.
The Board of Pharmacy must ensure that laws, regulations, policies, and practices promote the availability and use of controlled substance drugs to patients for legitimate pain management. The Board encourages programs to help educate patients, the public, and licensed healthcare professionals about the effective use of medications in the treatment of various types of pain. The Board also recognizes that, with proper assessment, therapeutic planning, and follow up, medications should be available and used when needed.
The Board of Pharmacy must ensure that laws, regulations, policies, and practices promote the availability and use of controlled substance drugs to patients for legitimate pain management. The Board encourages programs to help educate patients, the public, and licensed healthcare professionals about the effective use of medications in the treatment of various types of pain. The Board also recognizes that, with proper assessment, therapeutic planning, and follow up, medications should be available and used when needed.
The pharmacist's role (as educator and manager) in providing drug therapy for patients in pain is extensive. If pharmacists are to provide complete pain management services, they must fulfill their responsibilities to:
1. Facilitate the dispensing of legitimate prescriptions;
2. Understand and learn about the effective uses of all pain medications, especially opioids and other controlled substances, in the management of pain;
3. Carefully explain dosage regimens, and discuss potential side effects of pain medications;
4. Monitor and assess the patient for effective pain therapy outcomes, evaluate compliance, assess for tolerance to opioids, and ensure subsequent dosage adjustments as needed
5. Obtain, retain, and update appropriate information documenting the course of, and need for, on-going opioid therapy;
6. Encourage patients to talk with their pharmacist about their medications, the benefits and problems;
7. Discuss and allay patients' possible fear of addiction with the use of narcotics where this is a factor;
8. Watch for patients who misuse their prescriptions and be especially aware of a patient or family history of substance abuse that might complicate pain management and act accordingly;
9. Assess the patient for adverse drug reactions from the pain therapy regimen and take action to minimize or eliminate them;
10. Be aware of and recommend non-medication treatments for pain or refer patients for such when appropriate;
11. Evaluate OTC, prescription drugs, and alcohol taken with pain medications for potential drug interactions;
12. Recognize that patients and caregivers are important sources of information in assessing the patient's pain therapy;
13. Act as a liaison between patients and other healthcare providers, ensuring that there is open communication and understanding about the drugs patients are taking to reduce pain; and
14. Optimize pain management so patients can reach their highest level of functioning and quality of life.
ROLE OF OPIOIDS IN PAIN MANAGEMENT
Many patients with cancer or chronic medical conditions experience moderate to severe pain that is often inappropriately treated or undermedicated. Pain can have a negative effect on the patient's health and quality of life resulting in needless suffering, emotional distress, loss of productivity and possibly slower recovery from illness, injury, and disease.
Although there have been significant advances in knowledge about pain and the use of opioids and other medications in pain management, many licensed healthcare professionals prescribe, dispense, or administer these medications suboptimally. There is a misconception by patients, the public, and some licensed healthcare providers that opioids are "bad" drugs because opioids are often associated with drug abuse, addiction, and criminal activity. Studies have shown that opioids used appropriately for pain management have an extremely low potential for abuse.
The Board understands that the ongoing use of opioids for cancer, post-surgical, and chronic pain is not what causes addiction or a patient's desire for higher doses of pain medication. Patients suffering from extreme pain or progression of disease may require increased doses of medication; the appropriate dose is that which is required to adequately treat the pain, even if the dose is higher than usually expected. In addition, with long-term treatment of pain with opioids, patients may develop a tolerance to the drug or a dependence on the drug. These occurrences are considered "normal" and "to be expected" - they should not be confused by the licensed healthcare professional with drug addiction or be mislabeled as "drug seeking."
The Board understands that an important part of effective pain management is ensuring that patients do not have difficulty obtaining adequate medication for pain relief. The Board recognizes that is it the professional responsibility of the pharmacist to recommend that patients in pain received appropriate, timely, and adequate drug therapy to reduce their pain.
CONCLUSION
Recognition of the utility of opioids and other controlled substance drugs for the treatment of pain resulting from a variety of conditions is well established. The need for regulators and practitioners to understand this use, and to adopt laws, policies, and practices is self-evident if patients are to receive relief from pain which is now medically possible. In addition, pharmacists must understand their role in the on-going monitoring and assessment of patients' pain management. Working cooperatively, the Board of Pharmacy and the profession can ensure that opioids and other controlled substance drugs are used appropriately and effectively.
In: HEATH NOTES Pain Management 1996