Medication Management

As with all medical treatments, there are risks and benefits associated with treatment specific to each class of medications. The opioid medications carry with them certain special risks inherent to this class of medications that need to be understood before commencing treatment. Because these substances have been utilized since the time of the Egyptians, the characteristics of patients that are at risk for utilizing these medications is well understood. Patients with a personal or family history of substance abuse are at risk for developing abusive behavior with this class of medication. The incidence of a substance abuse disorder in the general population has been estimated to be anywhere from 2-5 percent and possibly higher.

Because of the above issues, and because these medications are controlled substances and regulated by the state and federal government, pain specialists must utilize them in a highly controlled and monitored manner. Patients and their families are educated regarding these medications and our program by the physicians and nurses at the Pain Specialists of Greater Chicago. Two documents must be fully understood before treatment can be undertaken with the opioids. These documents are 1) an informed consent to treat with opioids and 2) a controlled substance agreement form. They outline the risks and benefits of treatment with this class of medications and describe the patient's responsibilities when treated in this program. The third form used in our practice is an incident form which must be filled out anytime there is a discrepancy between the patient's regular opioid prescription and the patient's use of the medication or when there is a need to change the prescription in any significant manner (ie. early refills).

Adherence to the particulars of our medication program and the stipulations in the forms described above is monitored on an ongoing basis. Intermittent urine testing is utilized in the office as well to monitor the safe use of these medications. With these safeguards in place, the Pain Specialists of Greater Chicago are able to treat pain appropriately while monitoring their patients for evidence of diversion and abuse of these medications which, unfortunately, can and does occur. When abusive behavior develops, the Pain Specialists of Greater Chicago will make every effort to help these patients find care in local substance abuse programs while treating their pain by other means. Diversion, or obtaining prescriptions to sell the medications to those with substance abuse disorders, is a felony and will be reported to the appropriate law enforcement agents if discovered.

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