Journal of Urgent Care Medicine

Management of Patients on Low-Dose Naltrexone: A Clinical Review for Urgent Care Providers

Urgent message: Low-dose naltrexone (LDN) is becoming more common as a treatment option for pain and thus will be increasingly prevalent in patients presenting to the urgent care setting. A thorough medication history, prioritization of non-opioid treatment options, and timely referral or transfer for severe uncontrolled pain are important considerations in the management of patients using low-dose naltrexone. Ting-Hsuan Chiang, MD; Kenneth Schmitt, BS; Ariana Nelson, MD INTRODUCTION Naltrexone is an opioid receptor antagonist approved …

Come the New Year, DOT Needs You to Test for Opioids

The Federal Department of Transportation (DOT) is getting with the times and adding opioid screens to its drug testing program. Specifically, providers who conduct physicals and assessments for the DOT will have to include hydrocodone, hydromorphone, oxymorphone, and oxycodone in their screens as of January 1, 2018. In addition, methylenedioxyamphetamine has been added as an initial test analyte, and methylenedioxyethylamphetamine has been removed as a confirmatory test analyte. Adding the four semisynthetic opioids has been …

FDA Appeals Directly to Physicians on Curbing Access to Opioids

The FDA may have limited authority to reduce the number of opioid medications in circulation at any given time, but its commissioner, Scott Gottlieb, MD, is appealing to urgent care physicians, and prescribers everywhere, to take action. For starters, he said, the agency would like to construct “expert guidelines” informed by the medical community, with the idea that those guidelines could ultimately be reflected in drug labeling (over with the FDA does have authority). Speaking …

UCA Webinar: Stay in Good Stead with the DEA on Opioids

Efforts to stem runaway abuse of opioids—and the resultant increases in addiction and deaths—are firing on all cylinders from the White House to the state house. On a more local level, failing to get on board with current regulations can land you in hot water with the DEA. The Urgent Care Association has asked Ronald Chapman, II, an attorney well versed on the subject, to provide a brief primer on DEA compliance with topics that …

Express Scripts Is on the Same Page with the White House on Opioids

President Trump recently declared the epidemic of opioid addiction and related deaths to be a national emergency, pledging the federal government would spending more money and pay more attention to stemming the crisis. While details are still to come, theoretically future actions could include mandatory education for prescribers nationally and increasing funds to treatment and prevention programs. Coinciding with that, Express Scripts, the nation’s largest pharmacy benefit manager, is trying to restrict access to opioids. …

There Are Still Too Many Prescriptions for Low Back Pain

It’s been more than a year since the Centers for Disease Control and Prevention recommended that opioids not be used to treat chronic back pain. Unfortunately, too many prescribers have yet to get the message, according to new data from an NPR-Truven Health Analytics Health Poll. The data, reflecting the experiences of 3,002 patients participating in a telephone survey, show that 40% of the visits to a doctor for low back pain ended with a …

DOT Wants to Add Opioids to Drug Panels

Mindful of the rampant overuse and abuse of opioid medications, the U.S. Department of Transportation has proposed adding four of the most common—hydrocodone, oxycodone, oxymorphone, and hydromorphone—to its list of drugs that drivers must be screened for in urine analysis tests. Following through would bring the DOT testing protocol up to date with current Health and Human Services guidelines. There’s no date set for when the proposed changes would take effect. Urgent care providers who …

Should Reproductive-Age Women Receive Opioids?

The Centers for Disease Control and Prevention notes that use of opioids in pregnant women can lead to birth defects, suggesting that alternatives for pain management of severe pain should be considered. In addition, more thought needs to be given about the wisdom of providing opioids to women who are of childbearing age and not using birth control. However, a study published in Morbidity and Mortality Weekly Report found that opioids are prescribed to over …

Think Twice Before Prescribing Opioids in the Urgent Care Center

Urgent care clinicians practice where the rubber meets the road—treating patients who feel so bad they cannot wait to be seen by their primary care physician. The downside is that physicians often don’t know patients well—which means they need to be vigilant for opioid addicts and “patients” who are actually looking to obtain drugs so they can sell them for their own profit. This has given birth to a movement seeking to lower prescribing rates …