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Advanced directive prevents iatrogenic relapse for at-risk patients
e-Reports, Jan. 12, 2015
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Patients recovering from prescription and nonprescription drug abuse risk relapse when faced with surgery or other major medical procedures. In response, two physicians and a pain management clinician offer a tool to facilitate communication between the patient and physician.

Prior to an event, the “Advance Directive for Addiction in Remission and to Ensure Continued Recovery” form establishes a prescriptive plan for post-operative pain management.

“Recovering patients can get into trouble with relapse because people are not communicating,” explained Fred Frick, M.D., medical director of the IU Methodist Chemical Dependency and Chronic Pain Program and medical consultant to the ISMA Commission on Physician Assistance. “Many times, patients are reluctant to share their history of addiction with another physician.”

Jim Ryser, MA, LMHC, program manager of the IU Health Methodist Hospital Chronic Pain Management Program, first proposed the idea for a directive when facing his own surgery. Ryser, who is recovering from opiate addiction, worked on the form with Dr. Frick and John Ellis, M.D.

“Using the advance directive took me out of the driver’s seat for my addiction,” explained Ryser.

“It provided a game plan to avoid relapse.”

Specifically, the document details for the attending physician:

  • Patient’s history of medication addiction
  • Name of the responsible party for post procedural take-home medications
  • Responsible prescribing clinician and/or pharmacy
  • Current treatment agreement

“The goal is to make physicians aware of the potential risk of relapse,” noted Dr. Ellis. “We encourage everyone to use it and provide any suggestions on how to improve it.”

This year, Dr. Frick and Dr. Ellis plan to introduce a resolution to the ISMA House of Delegates encouraging voluntary use of form. Find it, along with a sample letter for an attending physician, here.

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