A POCKET BOOK GUIDE FOR PRESCRIBERS

METHODS FOR SAFER PRESCRIBING IN TRIBAL COMMUNITIES IN OKLAHOMA

Author Note

This publication was made possible through a grant from the Center for State, Tribal, Local, Territorial Support grant, which is housed within the Center of Disease Control, to the Southern Plains Tribal Health Board under cooperative agreement NU38OT000265. The content of this document is the responsibility of the author and does not necessarily represent the official position of the CDC.

Correspondence concerning this publication should be addressed to Casey Ward-Freeman.

Contents

1. Chronic Pain Management Guidelines a. The Treatment Team b. CDC’s Opioid Prescribing Guidelines Applied to Native Communities c. Multidisciplinary Pain Management i. Treatment Alternatives to Opioids for Native Patients ii. Treating Patients in Recovery

2. Laws and Policies of Safer Opioid Prescribing for Non-palliative Care

Address

9705 S Broadway Ext, Suite 200, Oklahoma City, OK 73114 Email cward-freeman@spthb.org a. Oklahoma State Laws and Policies b. Indian Health Service Policies

3. Detecting Substance Use Disorders

4. Thank You

5. Resources

6. References

A Pocket Book Guide For Prescribers

1

Chronic Pain Management Guidelines

Section 1: Chronic Pain Management Guidelines

Please note that these guidelines should not replace the provider’s clinical judgment about the care of individual patients.

Chronic pain is any pain that lasts for over 3 months. The pain can persist, or it may come and go. Chronic pain often interferes with daily activities. It can lead to depression, anxiety, and trouble sleeping, which can make the pain worse.

Chronic pain is one of the most common reasons adults seek medical care in the United States, and American Indian/Alaska Native patients are 3 times more likely to experience chronic pain than non-Hispanic Whites (Dahlhamer et al., 2016; Ross et al., 2019). The treatment of chronic pain should be individualized, patient-centered, and focused on meeting functional goals.

The Treatment Team

Chronic pain management is often complex and time consuming. It can be particularly challenging and stressful for clinicians working without input from other clinicians, and treatment is more effective when the medical and behavioral health care professionals collaborate (Center for Substance Abuse Treatment, 2012).

A multidisciplinary team approach provides many perspectives and skills that can enhance outcomes and reduce the stress on individual providers. Although having all relevant providers work within the same system and under the same roof is ideal, a collaborative team often must be coordinated across a community. This combined effort requires the identification of a designated lead care coordinator and a good system of communication between team members and the patient.

A treatment team comprises a combination of two or more professionals according to the primary care provider’s discretion and the patient’s unique needs and may include any of the following:

+ Primary care provider

+ Addiction specialist

+ Pain clinician

+ Nurse

+ Pharmacist

+ Psychiatrist

+ Psychologist

+ Other behavioral health treatment specialists (e.g., peer support specialist, social worker, marriage and family therapist, counselor)

+ Physical or occupational therapists

Addiction specialists can make significant contributions to the management of chronic pain in patients who have Substance Use Disorders (SUDs). They can do the following:

+ Put safeguards in place to help patients take opioids appropriately.

+ Reinforce behavioral and self-care components of pain management.

+ Work with patients to reduce stress.

+ Assess patients’ recovery support systems.

+ Identify relapse.