Start with lowest dosage to allay patient's fears
Opioids meds resisted by some
An added challenge to changing a patient's pain medication due to a shortage of a specific drug is the resistance of many patients and family members to using opioid medications.
"When I was a hospice medical director, I spent much of my time allaying the worries and concerns of patients and their family members about the use of pain medications," says Porter Storey, MD, executive vice president of the American Academy of Hospice and Palliative Medicine. "The main concerns are addiction, side effects such as nausea or hallucinations, and development of an immunity to the effects of the medicine that would lead to increased dosage."
Because pain management is an important part of hospice and palliative care, it is important to take the time to educate the families and make sure that the patient receives a drug that will be effective, he says. For the initial start of any pain medication, start with a low dosage that the patient takes on a regular basis, he suggests. "After the patient realizes how much relief the drug provides, it is easier to adjust the dosage as symptoms change to effectively manage the pain," Storey says.
If a drug shortage makes a change in drug or dosage necessary, you might have to start the process again, he says. "You don't know how each patient will react to a new drug, so you must monitor side effects carefully with any new medication," Storey explains.
No matter which drug you use, pain management is only effective if the patient takes the drug in the manner you prescribe, he points out. "Drug companies are coming out with new methods of delivery, such as a thin wafer that dissolves under the tongue, that can help patients who have difficulty swallowing pills," Storey says.
Transdermal patches that deliver pain medication are another way to help patients comply with medication management, points out Phyllis Grauer, PharmD, CGP, RPh, clinical consultant at Palliative Care Consulting Group, a Dublin, OH-based division of HospiScript Services. Patches are not right for everyone, she points out. Everyone's skin is different, so the rate of absorption of the drug varies from patient to patient, Grauer adds.
"The rate of absorption for oral medication is more predictable," Grauer says. "Patches are also more expensive and not cost-effective if the patient can take a drug orally." However, if you have a noncompliant patient, transdermal patches might be a good last resort, she adds.
Need More Information?
For more information about hospice drugs affected by the Food and Drug Administration action, contact:
Phyllis Grauer, PharmD, CGP, RPh, Clinical Consultant, Palliative Care Consulting Group, A Division of HospiScript Services, 555 Metro Place North, Suite 325, Dublin, OH 43017. Telephone: (614) 306-0146. Fax: (888) 303-1632. E-mail:[email protected].
Porter Storey, MD, Executive Vice President, American Academy of Hospice and Palliative Medicine, 4700 W. Lake Ave., Glenview, IL 60025. Telephone: (847) 375-4712. Fax: (847) 375-6475. E-mail: [email protected].
To find updated information on drug shortages, go to www.fda.gov/cder, select "drug safety and availability" on the home page, then select "drug shortages" on the left navigational bar.
An added challenge to changing a patient's pain medication due to a shortage of a specific drug is the resistance of many patients and family members to using opioid medications.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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