Prescribing Opioids For The Addicted Patient

The mainstay of drug therapy for opioid addiction is substitution with either methadone or buprenorphine. Opioid substitution therapy is effective in decreasing misuse of opioids and other substances, improving adherence to treatment, reducing criminal activity, and improving individual function.55

Patients using a long-term illicit opioid or those receiving a maintenance prescription for addiction management will not derive analgesic benefit from their regular dose. For those using unprescribed medications, prescribed doses must include replacement of the patient's usual opioid and other chemical consumption.

There must be a frank discussion between the patient and team members regarding acceptable and unacceptable behavior in relation to prescribed drugs and the therapeutic goals. The patient must agree that adherence to the prescribed regimen will be monitored appropriately, including by means of random urine toxicology screening. Consequences of noncompliance with any part of the program must be explicit at the outset. All such discussions with the patient should be carefully documented and a copy given to the patient if necessary. This may take the form of a formal treatment contract, although the legal status of these documents is variable.56

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