Excerpts from "Ten Tips for Staying Out of Trouble"
by Barry Eliot Cole, MD, MPA

Barry Eliot Cole, MD, MPA, reviews medical records submitted to the Second Opinion Utilization program of the American Academy of Pain Management. He has identified several common practices that have resulted in problems for some physicians who prescribe opioids. Below are excerpts from Dr. Cole’s recommendations to help physicians reduce their exposure when prescribing scheduled drugs. The complete recommendations were published in the Fall, 2002, issue of The Pain Practitioner and can be accessed at www.aapainmanage.org/literature/PainPrac/V12N3_Cole_PrescribingOpioids.pdf.

For information about the Second Opinion Utilization program and other services and forms related to medication management offered by The American Academy of Pain Management, visit their website, www.aapainmanage.org.

1. Obtain a thorough history and perform a first rate physical examination on your patients to accurately determine what causes their pain.



2. Chart everything you see, think, feel and hear about your patients.



3. Obtain informed consent from your patients so there is no doubt about the treatment proposed.



4. Get your patients to agree to use only one pharmacy.



5. If you are not trained as a pain specialist, get a second opinion from a pain management specialist, a specialist in the involved organ system or a specialist in the overall disease process.



6. Prescribe long acting opioid analgesics on a time contingent basis so that stable levels are achieved.



7. See your patients who are receiving opioid analgesics on a regular basis.



8. Determine the minimum dose necessary to maintain function and useful activities of daily living by potentially trying to decrease the dosage (25–35%).



9. Order urine drug screens for your patients of concern to document that you are able to recover their prescribed medications and that you are thinking about their potential use of illicit substances.



10. Continue to receive opioid analgesic education.