Innovations In Clinical Neuroscience

MAR-APR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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R I S K M A N A G E M E N T 50 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE March-April 2018 • Volume 15 • Number 3–4 • All medications from other sources, including over the counters and medical marijuana, should be discussed and documented in the medical record. • Inform the patient on alcohol use restrictions. • Inform the patient of the risks of withdrawal. • The patient is responsible for preventing diversion. • The physician's prescribing policies, including, for example, the number and frequency of prescription refills, a policy regarding early or urgent refills, a policy regarding replacement of lost or stolen medication, etc. should be reviewed. • The physician should provide reasons for which drug therapy may be discontinued, such as violation of the treatment agreement. Note that compliance with all components of the overall treatment plan is expected. • Periodic re-evaluation of treatment is needed. • Provide a written warning to the patient disclosing the risks associated with taking extended release medications that are not in an abuse deterrent form, if the physician prescribes for the patient a hydrocodone- only extended release medication that is not in an abuse deterrent form. • Inform the patient of the limited evidence as to the benefit of long-term opioid therapy. • Inform the patient that one of the risks of opioid therapy is death. • The patient has the option to consent to the sharing of information with family members and other providers, as necessary. • Educate the patient and caregivers about the danger signs of respiratory depression and that someone should summon medical help immediately if a person demonstrates signs of respiratory depression while on opioids. • Discuss with the patient safe medication storage and disposal practices. Note: There might be other requirements related to prescribing controlled substances. APPENDIX 2. PRESCRIBING CONTROLLED SUBSTANCES: TREATMENT AGREEMENT Some, but not all states have promulgated various requirements and recommendations for treatment agreements when prescribing controlled substances. The following is a compilation of current individual state requirements and recommendations for treatment agreements. Prescribers should determine the state requirements for their state, and may want to consider incorporating these components: • The treatment plan objective or the goals of the treatment. • Patients shall be seen by the physician at appropriate intervals, not to exceed 12 weeks to monitor the patient and evaluate progress. • The patient should receive prescriptions from one physician. • The patient should have prescriptions filled at one pharmacy. • The patient agrees to random drug testing (blood, urine, hair, or saliva) and pill counts when requested. • A female patient agrees to notify the physician if she wishes to avoid unintended pregnancy and if she becomes pregnant. • he physician shall specify the rules for medication use (patient take the medication as prescribed; prohibition against sharing medication with other individuals). • The patient is responsible for safely using medication, meaning that the patient should store the medication in a secure location and safely dispose of any unused medication. • The physician shall specify the consequences for misuse. • Reasons for which drug therapy may be changed or discontinued (e.g., violation of agreement). • The physician's prescribing policies, including, for example, the number and frequency of prescription refills, a policy regarding early or urgent refills, a policy regarding replacement of lost or stolen medication, etc. • The physician will be available during emergencies or otherwise have a covering physician available in the event unforeseen problems arise and to prescribe scheduled refills. • The patient gives permission for communication between care providers. • The patient gives permission to share information with family members and other close contacts regarding recognition and response to overdose, including administration of an opioid antagonist, if necessary. • If the physician becomes concerned that there has been illegal activity, the physician may notify the authorities. Note: There might be other requirements related to prescribing controlled substances. Disclaimer: The content of these resources ("Content") is for informational purposes only. The Content is not intended to be a substitute for professional legal advice or judgment, or for other professional advice. Always seek the advice of your attorney with any questions you may have regarding the Content. Never disregard professional legal advice or delay in seeking it because of the Content.

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