Conduct random testing at least yearly and more often if the patient is at additional risk for misuse or diversion for sale. The preferred testing strategy uses a combination of an enzyme linked immunoassay (EIA) for abused illicit substances and gas chromatography/mass spectroscopy (GC/MS) or liquid chromatography/mass spectroscopy (LC/MS).
A trusting patient-clinician relationship is key to the development of an effective treatment plan for chronic pain. Construct a unique plan for each patient, taking into consideration the individual’s experience, circumstances, and preferences. The treatment plan should involve multimodal interventions, promote self-management, and enlist the involvement of a health care team.
Buprenorphine can be prescribed for pain without an XDEA waiver, but the waiver is required to prescribe medication-assisted therapy for opioid use disorder.
It may seem hard to quit “cold turkey,” where you stop smoking suddenly. But Dr. Solanki says studies show that whether you taper your cigarettes or quit cold turkey, the results are the same.
Urine drug testing is important for verifying the patient is actually using the prescribed medication, and is not selling it or providing it to others (called “diversion”). Urine drug testing also helps with patient safety, by assuring through testing that other sedating substances or medications are not in use.
Assess factors that indicate whether opioids may be beneficial. Based on pain assessment, characterize the patient’s pain based on:
Transdermal buprenorphine (Butrans and generic) is FDA-approved for treating pain. It does not require an XDEA number or training to prescribe. The transdermal form is a good alternative for patients who have developed tolerance to other opioids, had a benefit from opioid treatment but wish to escalate treatment, and more info are taking ≤ 80 MME/day. Start with a 5 or 10 mcg patch (changed weekly), and discontinue other opioids.
If other treatments are not helpful, medication such as varenicline and bupropion can prevent cravings for nicotine and withdrawal symptoms.
And taking certain prescription sleeping pills can lead to drug misuse or drug dependence, so it's important to follow your health care provider's advice.
Special safety hazard and unique advantages. Methadone is unique among opioids, with both increased safety concerns and advantages in long-term therapy. The safe use of methadone requires knowledge of its particular pharmacologic properties. Methadone’s duration of adverse effects far exceeds its analgesic half-life, making it dangerous when combined inappropriately with other controlled substances.
Initiation of sublingual buprenorphine can provoke acute opioid withdrawal if not done correctly. Therefore, only prescribers trained in its use and in possession of an XDEA number (or working under guidance of such a prescriber) should initiate sublingual buprenorphine/naloxone. Once a patient is on it and stable, primary prescribers may take over chronic management.
Behavior changes learned through cognitive behavioral therapy are generally the best treatment for ongoing insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine later in the day, avoiding daytime naps and keeping stress in check also are likely to help.
They reduce cravings and withdrawal, making quitting easier. Have a healthcare professional find the best NRT for you. Additionally, prescription medications like bupropion and varenicline can reduce cravings and ease the process. Consult your doctor to explore the best options for you.
It may be tough at first to fight off those cravings. You may experience withdrawal symptoms within the first few days like moodiness, irritability and headaches as your body gets used to not having nicotine.