Lynn Webster, MD
Reviews
Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners
Authors: Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove.
Publication Date: June 2007.
Publisher: Sunrise River Press.
Length/Cost: 202 pages, soft cover (6” x 9”); $24.95 USD (ISBN 978-0-9624814-8-2, Item #SRP148).
To Order: Available online from: http://www.amazon.com (enter authors or title into book search).
Pain-Topics.org Reviewer: Stewart B. Leavitt, MA, PhD, June 2007.
Of all prescribed drugs, opioid analgesics incur the greatest misuse and abuse. Although these agents can be dangerous in the hands of the “wrong” persons, opioids are also beneficial or even lifesaving for millions of people who otherwise would live with chronic pain, and they are often the first-choice therapy for acute and postoperative pain.
Yet, healthcare providers are often caught between their professional obligation to relieve suffering and their desire to avoid contributing to the misuse or diversion of controlled substances. Therefore, Avoiding Opioid Abuse While Managing Pain is a much-needed guide for all practitioners concerned with pain management and opioid pharmacotherapy, written by leading pain expert Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove of Lifetree Pain Clinic. In a mere 202 pages, the text clearly sorts out the clinical, regulatory, and ethical issues associated with opioid analgesics.
Much already has been written on the subject of this book and the information presented here is based on the works of numerous experts in the fields of pain management and addiction medicine – all duly referenced. On one’s own, it could take weeks to access and read the many documents consulted for this book or, much better, one can invest several hours studying the 8 chapters in which Webster and Dove have already done the hard work of assembling the best resources available and interpreting them in a concise and, most important, useful fashion. Even a quick reading of Avoiding Opioid Abuse While Managing Pain will certainly provide helpful understandings and actionable ideas for any healthcare practitioner; however, there are too many ideas to absorb at once, so this also is a book that should serve as an ongoing reference.
This book presents a balanced perspective in advocating effective pain control via opioid analgesics, when appropriate, yet cautioning the reader about the many associated risks and pitfalls. The authors include step-by-step protocols for assessing patients’ risks of opioid abuse as well as for legally protecting the opioid prescriber. An emphasis is on acknowledging and addressing drug-related behaviors that sometimes compromise effective pain treatment with opioids. Therefore, little space has been devoted to clinical pain management itself; for this, the authors refer readers to two other guides [available for free access here, click on link]: A Clinical Guide to Opioid Analgesia and The PainEDU.org Manual: A Clinical Companion.
Webster and Dove point out that primary care physicians, nurse practitioners, and other first-contact clinicians are uniquely positioned to make a difference at the beginning of medical treatment. Research indicates that a patient with chronic pain or a substance-use disorder is far more likely to seek treatment from a general practitioner than from a specialist. This creates an opportunity for front-line healthcare providers to maximize the chances for success when patients begin opioid therapy. However, they note, “The challenge is to curtail the abuse and diversion of prescription opioids while ensuring their availability for patients who benefit from their use.”
Law-enforcement and other regulatory agencies often seem to take an intense interest in whether patients are misusing, diverting, or becoming addicted to prescribed opioids. Yet, Webster and Dove assert, “The need to watch for aberrant behavior does not mean that a clinician is legally obligated to always be right about a patient’s motivations and can never be fooled. Physicians and other healthcare professionals assess their patients for opioid compliance to ensue the efficacy of pain treatment and to diagnose and treat any possible complicating disorders. They are not responsible for any patient’s choice to behave irresponsibly or criminally.” This book provides the tools for detecting opioid risks and documenting their presence, and then for developing treatment plans and compliance monitoring strategies that can benefit patients while protecting prescribers in the event of legal/regulatory scrutiny.
About the authors: Lynn Webster lectures widely on the subject of preventing opioid abuse and criminal diversion in chronic pain patients. He is board certified in anesthesiology and pain management and also is certified in addiction medicine. In his private practice, he treats chronic pain patients, many of whom have complex diagnoses, as well as opioid-addicted patients. Beth Dove, a medical researcher/writer and former journalist, works full time with Webster. A portion of the profits from this book will be donated to Lifesource (http://www.lsource.org), a nonprofit organization founded by Webster and William L. Townsend that is devoted to curbing prescription drug abuse in America.
Review
This book is ideal for those clinicians who need assistance in understanding the proper way to manage chronic pain in patients on opioid therapy. It comes very highly recommended
---Journal of Palliative Medicine, 2008
---------------------
By E. Hall
This review is from: Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners (Paperback)
According to Dr. Steven D. Passik, PhD from Sloan Kettering Cancer Center, "this work brings it all together for the practitioner, on the ground, in the clinic, taking care of the complex people in this world with chronic pain. This book provides a know-how to do it safely, avoiding contributing to drug abuse and diversion." As a former Representative and District Manager for a company that promotes a chronic pain medication, I believe that "Avoiding Opioid Abuse, While Managing Pain" is a book that should be read and utilized by all those faced with the challenge of treating pain. It touches on issues that clinicians struggle with every day, such as: legal issues involved with opioid prescribing, risk factors for opioid abuse and clarifying terms like tolerance, physical dependence, abuse and addiction. Dr. Webster presents the reader with tools which help to assess patients that may be at risk for opioid abuse such as ORT "Opioids Risk Tool" or SOAPP. He also provides insights into how to monitor patients to minimize opioid abuse by looking at outcomes such as: pain relief, psychosocial functioning, side effects of treatment, and addiction related outcomes. Chronic Pain is a growing problem and yet in many cases goes undertreated due to fear and a lack of training, and knowledge from those in the trenches treating such patients. This book fills in those gaps of education and training and provides the practitioner with the know-how and confidence needed to tackle the abuse and diversion associated with prescribing opioids and ensure that the same medications are available for the patients who greatly benefit from them. I enjoyed reading this book and believe that it will give all those treating pain the confidence needed to manage such patients and restore some degree of function to their lives.
By Brian Buschman
This review is from: Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners (Paperback)
As a physician who has practiced more than a small amount in the area of pain managment I highly recommend this book. Espically to the resident or new primary care physician who may not be studying pain managment specifically but needs to understand proper legal documentation, consent and patters that will trigger or get you jammed up in an audit.
-----------------------
By A Pain Patient "A Pain Patient"
This review is from: Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners (Paperback)
I was delighted to receive the book entitled, "Avoiding Opioid Abuse While Managing Pain". Last night, I stayed up and read through the whole book. It is a masterpiece, especially to the layman. Lynn and Beth are to be commended for this outstanding volume. It will be a valuable resource!
