Rheumatologists managing pain should advise patients on opioid regulations
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SAN DIEGO — Rheumatologists must advise patients who receive opioids about the various regulations governing their use, according to a speaker at the Congress of Clinical Rheumatology West.
“There is no question that there are a lot of cooks in this kitchen, regarding opioid regulations,” Kevin Zacharoff, MD, a clinical instructor and the pain and addiction course director at the Renaissance School of Medicine, at Stony Brook University, in New York, told attendees. “There are a lot of voices and a lot of things that are being yelled at us.
“My recommendation to you is that you really start with the state-level requirements,” he added. “That is the most important thing to think about.”
The Federation of State Medical Boards is likely the single regulatory agency that has the most impact on any single practice, according to Zacharoff. However, boards from different states often have different regulations and requirements.
“Whatever your state medical board wants you to do, is what you need to do,” Zacharoff said. “It would be really nice if every state medical board agreed with each other.”
Rheumatologists should also be aware of regulatory practices of the CDC and FDA, he added.
Aside from recognizing and adhering to the practices set out by regulatory agencies, it is important to practice proactive education with your patients, Zacharoff said.
“I really and truly believe that education is the single-most important weapon that we have,” he said. “I think discussing these issues with patients is really important.”
When discussing issues surrounding pain management with patients, rheumatologists should avoid presenting procedures like toxicology screens as “punitive,” according to Zacharoff. He added that it is important for patients to understand their responsibilities when they are prescribed opioids, noting regulations that prohibit patients from sharing prescriptions with family members. Topics including past history with opioids — both of the patient and in the family — drug storage and disposal should also be discussed.
“If you don’t let patients know that, and they save the drug for when their significant other has a toothache, or when their child gets hurt in a football game, and you didn’t warn them about that — that’s not informed consent,” Zacharoff said.
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Zacharoff K. Navigating regulatory waters in pain management. Presented at The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).
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