Who will prescribe? A proposal for specialized opioid management clinics

There is currently no uniform system of providing care for patients with chronic nonmalignant pain who require ongoing opioid maintenance therapy. Some patients receive care in a general practice setting, while others are managed in pain clinics where opioid management is only one of many services provided. Current events involving increased abuse and diversion of opioid medications suggest the need for improved case management and coordination when opioids are used for chronic nonmalignant pain. Based on the model of anticoagulation clinics, the author proposes the development of specialized opioid management clinics. These clinics would: 1) evaluate patient-specific risks and benefits of therapy; 2) supervise the mechanics of opioid prescribing; 3) provide systematic and secure monitoring of patient adherence to therapy; 4) assess goals of therapy and progress towards them; 5) coordinate opioid treatment with other pain-related treatment; 6) supply education to patients, family members and caregivers about the appropriate use of opioids; 7) maintain communication with other caregivers and pharmacists; and 8) provide regular psychological assistance and support for patients.