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by Marilyn Medger
3-day limit on most narcotic prescriptions for acute pain
LAKELAND — As Florida’s new law on opioid prescriptions went into effect Sunday, patients seeking relief from pain may find there have been changes in what they are prescribed, the dosages they are given and perhaps even in the physician who will treat them.
The most publicized part of the law is the limiting of opioid prescriptions to three days, seven days if a physician documents that it is medically necessary, for people with intense pain from surgery, a traumatic injury or an acute illness. Patients with such acute pain will have to be reassessed by a physician to get a refill at the end of a three-day or seven-day prescription.
Patients with chronic, long-term, debilitating pain, including those with cancer pain and those needing palliative and end-of-life care, are not limited to the three-day or seven-day prescriptions.
Recognizing that drug overdose is the leading cause of accidental death in the United States, the Florida Legislature enacted the complicated law in an effort to reduce addiction from opioid medications. The intent is to encourage physicians to prescribe the lowest dosages that will take the edge off intense pain or to use alternative medications and therapies.
The new Florida laws taking effect July 1
Emergency department physicians and surgeons have already been working to reduce the use of opioids, said Dr. Timothy Regan, an emergency medicine physician who is chief medical officer for Lakeland Regional Health.
There is general recognition that a past trend encouraging physicians to try to eliminate pain has led to over-prescribing, which fueled the opioid epidemic, Regan said.
The federal government has changed verbiage hospitals must use when patients are asked about their hospital stay, Regan said. The question used to be how well have they controlled your pain; now the question is have they talked with you about your pain.
“This allows prescribers to address pain control in a more conservative way” rather than encouraging over-prescribing, Regan said.
Chronic-pain patients who have been using opioids, such as for back pain or knee pain, should still be able to get their medications, but they might see some differences under the new law.
“We have been educating our patients in advance,” said Dr. John Ellington, who is in charge of risk management at the 200-physician Watson Clinic in Lakeland. Posters explaining the law have been up at the clinic’s various facilities and the clinic’s website posted an article explaining the law, he said.
The law requires physicians to go through several steps when prescribing opioids for chronic pain, and some physicians may not want to go through all those steps and take the risk of making a mistake that could end up with a censure or, for flagrant violations, a criminal charge, Ellington said.
“Will some doctors not prescribe opioids at all? Certainly,” Ellington said. Although, he added, most physicians likely will make adjustments to their practices and continue to prescribe.
In order to prescribe opioids, physicians, osteopaths, dentists, optometrists, podiatrists, nurse practitioners, physicians and others who are allowed to prescribe controlled substances must:
• Register with the federal Drug Enforcement Agency.
• Complete a two- or three-hour course on prescribing.
• Register under their medical license that they treat chronic pain.
• Document the patient’s pain and make a written plan for treating the pain.
• Check the state database to see whether there are other narcotic/opioid prescriptions for the patient.
• Check the patient’s photo ID against the medical records.
• And enter the prescription into the state database by the end of the next business day.
“A lot of people may feel uncomfortable doing that,” Ellington said. Some might decide to no longer prescribe opioids, even to long-term patients with chronic pain. They might refer them to a pain management clinic for treatment.
Regan said that pain management specialists likely will see a spike in business because of the referrals. However, pain management specialists are trained in not just narcotic medications but also in alternative medications and alternative therapies, which might end up being in the best interest of the patient, Regan said.
Dr. Francisco Chebley, medical director of the large Lakeland Regional Health Physician Group, said that if a doctor has been comfortable writing prescriptions, the new law should not be a major obstacle.
“It is a little bit of an extra step” to check the database, “but should not cause a deterrent.” Chebley said. “It is only a matter of a few seconds to log in” to the database.
“A doctor should be aware if a patient has been doctor shopping” in an attempt to obtain extra narcotics, Chebley said.
Regan said that Lakeland Regional is working to incorporate access to the database with its electronic records system, making it easier for doctors to check whether a patient has other opioid prescriptions.
Patients should be aware their doctor will ask them more questions, but it’s not because their doctor doesn’t trust them, Regan said. “Physicians are being held accountable to prescribe in a responsible way, and patients should be aware of that.”
The law also addresses what pharmacies must do to check the legitimacy of prescriptions and ensure a patient is not being sold multiple narcotics from a variety of prescribers.
“There is nothing about this law that means legitimate patients cannot get legitimate medicine for legitimate reasons,” Ellington said.