ISSUES IN OPIOID ASSESSMENT Types of Painkillers (synthetics typically give better highs) Short acting: Lortab (very common), percocet, vicodin oxycontin lasts 12 hours; ms contin – morphine sulphate; lasts 12 hrs. 24-hr ms contin now available(kadian?) duragesic fentanyl patch lasts 3 days; check used patches for tampering (can get patches on the internet) ultram (not an opiate) some may combine soma (a muscle relaxer) and lortab gives good pop

Assessing Need for Narcotics (opioids) realize very few chronic pain clients are “addicts” assess for prior and current alcohol/drug problems assess for self-medicating of psych disorders do drug screen; do they already have drug in them? Are they diverting their meds to the street? (oxycontin going for about $1 per milligram) check pharmacies for multiple rx asses pain level on and off meds – are they helping functioning?

Assessing Need for Narcotics (opioids) check compliance with medical tx – if client only wants narcotics, be suspicious…are they willing to sign a “medication use” agreement/contract? are there secondary gain issues involved? (e.g., workmens comp.) poorer pain tx outcomes are associated with those in litigation. type and dosage of drug currently taking; in some, tolerance is so high that withdrawal symptoms (increased pain) may occur when taking a typical dose rural vs. urban setting: rx drug abuse worse in rural areas

Assessing Need for Narcotics chronic opioid tx not appropriate for: those with active addictions those who use etoh (liability) those who refuse other types of tx when QOL not improved after use of meds for those with previous narcotics problems opioids not given for lengthy amounts of time need to be in tx / NA client may underestimate risk of relapse

Other Forms of Pain Management epidural nerve blocks radio frequencies; zap nerve and deadens for up to 6 months electrical stimulation: blocks pain signals relaxation techniques Biofeedback physical therapy / chiropractic Acupuncture morphine pump in body other medications Antidepressants Neurontin