OK, being a pediatrician, while I still have patients with Crohn's or Dermatomyositis or other illnesses with chronic pain, I am nowhere near in the realm that FP and IM would be.
Not sure if the new guidelines are federal or state, but I know that our state just passed some significantly strict guidelines on opiates. We have what is one of the highest states for narcotic abuse in the nation. Sorry: (Maine).
Allowed to use EPCS, but it isn't mandatory yet. Will need to get almost all patients down to an MME of 100 mg of Morphine by 2017, but should be starting now. Cancer patients and other exceptions will be exempt. Patients that are already at or just over 300 MME can get that amount but must have a diagnosis, a medication is medically necessary and a statement of intent to wean on the script. I believe if you are still over 100 MMEs by 2017 or so, you have to refer out to a pain specialist. You will also have to check the PMP (the state registry for the prescription record of the patient) prior to each visit. Not sure if that will be attestation or if they will check how often you are using it.
Anyway, I wanted to get opinions on what others are doing as far as giving scripts to chronic users. We have been a bit lenient, and I want to tighten that up.
To give a little background, new users of CII such as Adderall, are seen monthly times three, then every two months times three, then every three months thereafter. They are given three months worth's of scripts.
I don't know how, but our chronic narcotic patients (which are probably 1/25th of the amount of ADHD med patients) seem to be under less strict guidelines.
Today we had an example of not only poor prescribing on a patient as far as some errors were concerned, but the amount of time spent correcting them was not reimbursed. If I am going to spend time looking up the PMP, which takes at least three to five minutes to log into, plus go over pain control and what they are on, and tapers and explaining the laws to them, I may as well get paid for it. Plus, it is just better patient care.
But, if a patient, say with Crohn's who needs 30 mg q12 hours of Oxycontin each month, how often should I see this patient? Every month? Every two months? Three?
Any input as to what others do would be appreciated.
