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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.
References
here.

March 2023

Image of inherited patients taking opioids for chronic pain review

Dr. P Coffin and Dr. A Barreveld review the issue of inheriting patients prescribed opioids in this New England Journal of Medicine perspective.

February 2022

image of annals of medicine article entitled: primary care management of long term opioid therapy

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.

September 2022

image of Opioids for Chronic Pain Documentation template

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.

April 2023

image of an example epic smartphrase for chronic opioid treatment

An example Epic SmartPhrase with elements important for documenting chronic pain treated with opioid medications.

December 2021

image of an example policy on managing inherited patients on legacy opioid prescriptions

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.

March 2023

image of example letter to clinicians regarding continuity of care for legacy opioid patients

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. 

March 2023

The text of this letter may be copied and modified as needed to account for local conditions.

This webinar, presented by the CIAO team, focuses on patients prescribed long-term opioids who are abandoned when a clinic shuts down, or when a clinician relocates or loses their license to practice. The webinar begins with real cases about the morbidity, mortality, and challenges faced by patients in this situation, and explore resources available to clinicians who are hesitant to take on either inherited or abandoned patients. A mock detailing session also illustrates how to talk with clinicians about both the perils of abandoning patients on opioids and some best practices in initiating care for an abandoned patient. The articles mentioned in the webinar are linked below.

The DEA Shut Down a Pain Doctor. Now 3 People Are Dead.
This Vice article was published Jan. 5th, 2023. Find it here.
This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor.
This Vice article was published Nov. 30th, 2022. Find it here.
‘Entire Body Is Shaking’: Why Americans With Chronic Pain Are Dying.
This New York Times article was published Jan. 3rd, 2023. Find it here.
 

A Bibliography of recent articles addressing the risks associated with tapering or discontinuing opioids can be found here.

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