Advanced Pain Management
Opioid Prescribing Policy

The physicians at APM are committed to providing the best healthcare possible to our patients. We recognize that, for the most part, people come to see us because they are experiencing pain that interferes with their quality of life.

Our goals are to first identify, to the best of our ability, the cause of your pain and then educate you about various treatment options. We expect you to take an active role in your own healthcare. We can provide or facilitate many different conventional and alternative pain treatments.

We typically start with non-invasive treatments when possible, such as specific exercises, ergonomic changes, physical therapy, medications, and activity modification. When that is simply not enough, the full spectrum of intervention "blocks" and other intervention techniques are available here as well as acupuncture and prolotherapy.

Occasionally, when we determine that a particular condition is resistant to all of these tools, then we suggest the use of long-term opioids (narcotics). This decision is often made after we have been through a rather thorough process of evaluation and treatment trials.

The decision to start long-term opioid (narcotic) therapy is not made lightly. We must take many things into account, including issues related to any prior history or family history of substance abuse or prior history of drug-seeking or drug-diverting behavior. This includes deceiving your doctor in any way, doctor shopping, giving or selling your medications to others, or abusing alcohol or "street drugs." These issues are considered by most pain management specialists to be reasons not to prescribe long-term opioid use. Granted, this must be evaluated on a case-by-case basis and input from an addictionologist may be required.

Our policy regarding continuing to write for opioids started by other physicians is simply this: We reserve the right to evaluate the cause of your pain and make treatment recommendations that may or may not include the use of opioids. This means that just because your last doctor prescribed opioids does not mean that we will continue them, even if you are running out.

When opioids are considered part of the treatment plan, you will be required to read and sign our opioid prescribing agreement. You may be subjected to periodic drug testing. You may also randomly be called to show us your pills.

We routinely communicate with pharmacists, your other physicians, and your insurance company, and if we learn that you are going to more than one pharmacy or doctor and getting pain medication of any kind from someone other than your APM doctor, you will be asked to leave the practice. Please keep your opioids in a safe place and remove labels before you discard empty bottles.

We start patients on opioids with the best intention of helping to ease pain in order to improve function. If you develop drowsiness or dizziness, you should not drive a car or operate machinery as you may jeopardize the safety of yourself or others. Please notify us immediately if you experience side effects or if you have concerns about your medication. Constipation is a common side effect of consistent opioid use and can be addressed with either over-the-counter or prescription medications. If you abruptly discontinue your pain prescription, you may experience nausea, vomiting, sweating, anxiety, and increased pain. These symptoms are typical of withdrawal.

Occasionally, we discover during treatment that the use of opioids is not in your best interest. When this is the case, we will assist you in tapering off the medication and help you look at other treatment options.

Once opioids are prescribed, you will need to be seen at least every 3 months to receive your prescriptions; your doctor will decide this interval. Opioid prescriptions, once written, will not be replaced if lost. Most of our patients get at least a one-month supply of medication. Therefore, if you phone in for early refills, we will not oblige. Please do not wait until late afternoon, Fridays, evenings, or weekends to notify us that you need a refill, as we will not be able to help you until we have access to your chart, which may take 1-2 days.

You will be discharged from the practice at the discretion of the physician if you break any of the following rules. These include, but are not limited to the following:

If, at any time during our therapeutic relationship, we believe that you would benefit from seeing a behavioral psychologist, we expect you to go. These services could include education in pain coping skills, biofeedback, self-hypnosis, and help with adjustment issues. These skills help to empower you and are often an essential ingredient in the success of an overall treatment plan.

We also work closely with local addictionologists, who are medical doctors specializing in the disease of addiction. If we believe this has become an issue for you, we will expect you to seek appropriate help in this regard. If you do not comply you will no longer receive opioid prescriptions from this practice.

We adhere to the guidelines set forth by the Commonwealth of Virginia Department of Health Professions Prescription Monitoring Program (see State Regulations).

Click here to download a printable copy of the Opioid Prescribing Policy