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We are pleased to continue our short series of articles in Partners in
Health UpdateSM that is designed to explore potential barriers
and opportunities to facilitate communication and collaboration between primary
care physicians and behavioral health providers and to achieve optimal outcomes
for your patients.
Part 2 – Behavioral health resources
available for assessment and treatment of opioid misuse and abuse*
Pain management is a complex issue for many primary care physicians (PCP).
Generally, PCPs are able to identify opioid abuse, but opioid misuse is more
difficult to pinpoint – especially in those patients with chronic
pain.1
Independence and Magellan Healthcare, Inc. (Magellan), an independent
company, are aware that opioid management is a current and relevant problem for
PCPs. As such, we are collaborating to provide resources for the assessment and
management of opioid misuse and abuse. The Chabal 5-Point Prescription Opiate Abuse
Checklist includes questions you may have already incorporated into your
daily practice. This checklist is a reliable and valid tool. Three positive
responses alert you to possible abuse of prescription opiates.2
The National Institute on Drug Abuse3 (NIDA), a subdivision of
the National Institutes of Health (NIH), provides resource tools for screening
patients for opiate misuse and abuse. Two such aids include:
- NIDA Drug Use Screening Tool. This online screening tool assists
providers in identifying risk of substance abuse and resources in patient care
and support.
- CAGE-AID assessment tool. The CAGE-AID assessment tool is similar to
the CAGE assessment tool for alcoholism, but adapted to assess for other
substance use.
You also can check an opioid database (state-based databases with information
on patients with opioid prescriptions that provide patient-specific data on
frequency, dose, and name of medication as well as a list of prescribing
practitioners) for patterns in member prescriptions and opioid use.
Additionally, the NIDA has a variety of assessment tools and questionnaires
that patients can complete before they see their PCP. This is especially
helpful if completed by new patients or patients requiring pain management for
the first time. These self-reported questionnaires provide valuable information
about patient history and behaviors that can contribute to opioid abuse. During
the course of treatment, the PCP can re-evaluate the patient and implement
strategies to more effectively manage these behaviors while providing pain
management. You can access screening tools and other resources via the NIDA website.
Magellan can assist with getting your patient
the right services
The relationship the PCP has with his or her patient with chronic pain is
valuable; this relationship creates a strong base to facilitate an open
discussion as well as help solve issues. As concerns arise, you may want to
start a discussion with your patient about your observations and alternatives
for pain management. This may be a difficult conversation to initiate because
of the social stigma of abuse and addiction attached to prescription pain
medication as well as the patient's own perceptions of pain and medication
use.
Fortunately, there are behavioral health providers available who can assist
with your concerns about your patients' behaviors. Magellan is available to
assist in matching the patient with the right behavioral health provider.
If you identify possible opioid abuse or misuse, you can:
- Encourage the patient to call the number on the back of their medical ID
card to arrange a referral to a behavioral health provider. A Plan staff
member will work with the member to determine the most appropriate resource
based on patient need and preference, provider specialty, and provider
location, as well as other specific patient requests or considerations.
- Contact Magellan directly (with patient permission) to request
assistance with connecting the patient to the appropriate behavioral health
provider.
Magellan's Behavioral Health Disorders
Toolkit
Magellan also offers access to a variety of collaborative behavioral health
materials, including substance use resources, through Magellan's Behavioral
Health Disorders Toolkit. Organized by category, the materials are designed to
give medical practitioners the information and screening tools needed to assist
in making behavioral health referrals. You can access Magellan's Behavioral
Health Disorders Toolkit, including information on CAGE and CAGE-AID screening,
via our Providers webpage or on the NaviNet® web
portal in the Administrative Tools & Resources section under Health and
Wellness.
Working together
We are committed to promoting integration of medical and behavioral health
services toward the goal of better
overall outcomes for patients and encourage you to access these resources.
Remember, you don't have to do this alone. Collaboration with a behavioral
health provider can enhance the treatment regimen that you and your patient are
developing to manage pain.
* These guidelines are not intended to replace a
practitioner's clinical judgment. They are designed to provide information and
to assist practitioners with decisions regarding care. The guidelines are not
intended to define a standard of care or exclusive course of treatment. Health
care practitioners using these guidelines are responsible for considering their
patients' particular situation in evaluating the appropriateness of these
guidelines. This information is not a statement of benefits. Benefits may vary
and individual coverage must be verified.
1 Hartrick, C,
Gatchel, R & Conroy, S. (2012). "Identification and management of pain
medication abuse and misuse: current state and future directions," Expert
Review of Neurotherapeutics, 12:5, 601-610, DOI: 10.1586/ern 12_34.
2 Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E.
(1997) "Prescription opiate abuse in chronic pain patients: clinical criteria,
incidence, and predictors," Clinical Journal of Pain, Jun: 13(2):
150-155.
3National Institute on Drug Abuse: www.drugabuse.gov/publications
Magellan
Healthcare, Inc. manages mental health and substance abuse benefits for most
Independence members.
NaviNet is a registered trademark of NaviNet,
Inc., an independent company.
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