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Inheriting Patients on Long Term Opioids: A Toolkit
Notwithstanding overprescribing of opioid medications, efforts to reduce opioid prescribing also carry risks. Perhaps most problematic is the sense of abandonment experienced by patients. Tens of thousands of U.S. patients receiving opioids are forced to find new providers each year. Few clinicians are willing to take on the care of these patients, and even fewer provide the type of continuity necessary for a safe transition of care.
The materials included here are directed at clinicians and regulators; they are for informational purposes only and do not represent medical or legal advice.
This <6 minute talk by CIAO Medical Director, Phillip Coffin MD, briefly reviews steps to support patients who have lost their provider.
Dr. P Coffin and Dr. A Barreveld review the issue of inheriting patients prescribed opioids in this New England Journal of Medicine perspective.
This Annals of Medicine article was written as a narrative summary of the CIAO guidebook and emphasizes the best practices in caring for patients who have often been ignored and stigmatized in healthcare settings as a result of their opioid use.
Documentation is critical to ensure patient well-being and protect clinicians from unnecessary scrutiny. CIAO has produced a review of elements important for documenting chronic pain treated with opioid medications.
An example Epic SmartPhrase with elements important for documenting chronic pain treated with opioid medications.
Clinics often produce policies that create barriers to accepting patients already prescribed opioids. CIAO has produced an example clinic policy regarding new patients on legacy opioids that can help to bridge that gap.
Example Letter to Clinicians Regarding Continuity of Care for Patients Treated with Buprenorphine for Opioid Use Disorder
The loss of a provider can be traumatic for patients, and loss of access to buprenorphine can be immediately life-threatening. Health departments or other entities might consider encouraging providers to continue buprenorphine treatment for patients experiencing disruptions in care. CIAO's example letter to clinicians encourages accepting patients receiving buprenorphine therapy for opioid use disorder.
The text of this letter may be copied and modified as needed to account for local conditions.
A Bibliography of recent articles addressing the risks associated with tapering or discontinuing opioids can be found here.
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