Opioid Pain Prescriptions—IPS Philosophy Explained
IPS physicians prescribe pain medications when medically necessary. We understand that patients living with moderate to severe chronic pain may need scheduled opioid pain medication to function better and control their pain when conservative measures have been exhausted. That being said, we do our due diligence to keep our community safe from our medications being diverted or sold on the street. If you plan on using illicit substances or making your pain medications available to others do not come to our office.
We follow state and federal laws. Any controlled scheduled medications require us to do random urine screens 3-4 times a year on moderate to high risk patients. We also monitor electronic state reporting services to make sure you will only obtain pain medication from us, not other physicians. You will sign a narcotic agreement. In the tristate the electronic reports are called KASPER(KY), OARS(OH) and INSPECT(IN). Pill counts although rare at IPS, could be asked of our patients. If you are working and can’t come in during daytime hours to count your pills, you would be asked to go to your pharmacy and have them count your pills that day after you leave your job.
We also look at alternative adjunctive medications that may help you. Anti-inflammatory, muscle relaxants, antidepressants, Gabapentin, Cymbalta, Lyrica and other medication classes with literature to support pain relief for your diagnosis.
If IPS and you as a team determine opioids are best for you or your loved one, you can be confident that it is being done safely. We are proud and it is remarkable for such a large practice for so many years to never have a deadly overdose because of one of our prescriptions.
Times are changing. The CDC has written guidelines for scheduled medications. Although we are not obligated to follow them to the letter, IPS attempts to comply. The national climate has turned against opioids. We at IPS pray for the day a better and safer pain medication is invented. The CDC warns that taking opioids with benzodiazepines (Valium, Xanax, Ativan, Klonopin) increase risk of overdose four-fold. For that reason, it is rare for an IPS physician to start a patient on a benzodiazepine if they are on an opioid. If a patient has proven they have been on both safely for years with strong medical necessity for both, we are more lenient. We care about the safety of our patients and the people around them, so we make Narcan injectors or nasal sprays available to all patients.
The CDC wishes when possible to avoid prescribing opioid doses that measure higher than daily 90 mg Morphine equivalents. That may be fine for patients naïve or in the first few years of taking opioids. Patients with significant tolerance and years of opioid use will struggle with this because they have millions more pain receptors that have to be filled before pain is relieved.
IPS physicians, meet frequently to discuss ceilings for the opioids we prescribe. We are aware there are patients who will be exceptions and need more than typical patients. Of course, patients with terminal diagnosis will be prescribed what is necessary to keep them comfortable in their final days. We cannot guarantee to prescribe exactly the same as your previous physician, however we will listen to you and do our best to come up with a customized plan that we believe will make your life better. We often find things previous doctors missed, have not thought of or were not trained to perform for you. We look forward to you giving us a chance to evaluate your pain.
Cannabis is a dynamic topic. CBD is a hemp product with many of the beneficial medicinal properties of Cannabis without the psychogenic THC component (0.3%). We currently are not releasing patients obtaining this legally. In the near future, IPS may get more involved in dispensing Cannabis products when legal nationally and it if research continues to show it to be a better alternative to opioids.
Procedures: Time and time again patients tell us their opioids are more effective when we lower their pain through our interventional procedures. Successful treatment can also give patients the option to stop opioids. After a thorough exam we may find you have an issue that will respond to one of our interventions. Please keep an open mind and consider trying what we do best or at least let us try a test injection. Dr. Hansen our founder, has had four back surgeries and suffers from severe degenerative disc disease. As a result, he understands spine pain better than most physicians. With the help of our procedures done yearly on him he has only missed one day of work in the last 16 years.
Lucemyra is new medication that blunts the severe side effects of withdrawing from opioids (abstinence syndrome). It may make it much easier for you to stop your pain medication when you are ready.
Also be aware in the last few years there are new medications to ease the horrible side effect of constipation from opioids. We prescribe them.
With my best regards,
Kendall E Hansen, MD Pres./CEO IPS