In some cases, medications may be useful to improve function and reduce pain. Long term opioid use, however, remains controversial as the conclusions drawn from medical research have not shown a long term functional benefit over other medications. Opioid medications along with other controlled substances carry risks of respiratory suppression, lethargy, increased depression, tolerance, abuse, and even death and are not appropriate in many cases.
It is commonly accepted that opioid medications are over- prescribed. In Colorado, there is an opioid crisis with more deaths attributed to prescription medication abuse or overdose than to motor vehicle collisions. The Governor has developed a task force to assess this crisis. Each prescription is closely monitored in this state. Pharmacies are increasingly scrutinizing and validating prescriptions and in some cases limiting quantities or refusing to fill the medications. CPC supports these efforts reduce medication overuse and inappropriate use.
The goal of all treatment for pain related conditions is functional improvement. Each treatment, including medication recommendations, must be assessed relative to its contribution to functional gains. The providers at CPC may consider using controlled substance medication to assist a patient, if and only if, an improvement in function can be documented. Our policy is to limit the use of short acting medications. In some cases, however, we will consider the use of long acting medications.
In order for a patient to be considered for medication management, a physician referral and review of prior medical records is required. This documentation must include a medical diagnosis of a pain condition warranting medication use in the opinion of our providers along with a description of all other treatments rendered for this condition and the outcomes. CPC providers will not prescribe medications in cases where appropriate non medication conservative care has not adequately trialed with the patient.
Each patient will be required to review and sign a detailed narcotic and practice policy contract. Random drug screens and pill counts are also required. In cases where there is a concomitant psychological or emotional issue that may compromise patient function, a psychological evaluation may be required.
Marijuana/THC is a Class 1 drug, currently illegal in the United States as determined by the federal government. While some states, including Colorado, have legalized the use of medical and/or recreational marijuana/use, federal law supersedes state laws in this regard. It should also be noted that there is limited medical research outlining the interactions and possible side effects that can occur when controlled substances are used with THC. Therefore, CPC prohibits the use of marijuana/THC for all patients on controlled substance medications.