“Information like history of substance use disorder or drug testing results indicative of illicit substance use are indicators for him that will not prescribe medication therapy.”
Leveraging High-Complexity Toxicology Testing Within a Multi-Faceted Risk-Assessment Approach to Pain Medication Management
Managing patients with chronic pain with opioid therapy and/or with interventional procedures requires a thorough understanding of the patient’s history, current presentation, and overall risk. Dr. Tyrus Soares is a pain management physician in Omaha, Nebraska, and he uses definitive testing as one of the risk assessment tools in his protocol. Dr. Soares utilizes numerous tools in determining the risk level of the patient such as the Screener and Opioid Assessment for Patients with Pain (SOAPP), Opioid Risk Tool, medication history, and previous provider history, together with initial drug testing results to help inform decisions about whether a patient is a safe candidate for medication therapy.
“It’s not the result of any single screening tool that makes the determination about whether an individual is an appropriate candidate for medication management of their pain. There are multiple factors that I consider in deciding how to move forward with what treatment modalities I can offer to a patient,” Dr. Soares said. “Information like history of substance use disorder or drug testing results indicative of illicit substance use are indicators for him that will not prescribe medication therapy.”
Regarding ongoing risk assessment, Dr. Soares and his staff pay close attention to behavioral indicators that may signal a change in risk and possibly an appropriate time to order definitive toxicology testing. “Reaching out for early medication refills or previously stable patients suddenly stating their medication is no longer effective at a particular dose or frequency are behavioral changes that may also influence my decision to test that patient and see what else I can learn from their toxicology results.”
In thinking about how the results of definitive testing have assisted with patient conversations and outcomes, Dr. Soares did mention that results often help increase transparency with patients about recent substance use. Marijuana use has become increasingly proliferative in Nebraska, especially due to bordering states that offer medical marijuana access. “When patients test positive for marijuana and potentially other substances, it allows us the chance to talk about why they are using it, where they obtain it, and the potential for other things to be laced in the marijuana depending on where they are getting it.” The results are used both to educate patients on substance use risks and help Dr. Soares make safer prescribing decisions as he considers how to best move forward with a particular patient.
“I use open-ended questions to help me understand their results. When did they last take their medication, or what could have contributed to the unexpected findings in their sample (such as a positive for an illicit substance)?” Dr. Soares said. “When illicit drugs are detected, I let the patient know that I cannot provide medication management, and we look to other clinically appropriate modalities for managing their pain besides opioid therapy.” Dr. Soares does make referrals to addiction care providers when clinically appropriate to ensure patients have an opportunity to seek the right path of care.
Dr. Tyrus Soares, Pain Management Physician
Dr. Tyrus Soares is a pain management physician in Omaha, Nebraska with expertise in treating neck pain and spine problems, among other conditions.
