Controlled Substance Policy
Narcotics and Other Controlled Medications, Disability Determination
To our present and future patients, in our clinic we do not prescribe any controlled medications of any type. Defined, I neither prescribe narcotics (short acting or long acting), nor muscle relaxers (including those that are not controlled medications), nor sleep medications of any kind. For patients that request a sleep medication I direct them to their local Pharmacist for advice in making selections from the many over-the-counter preparations. Regarding weight loss I do not prescribe any medications from that class called anorectics. The hope for weight loss is not worth the dangers of side effects and addiction from this class of medications.
Autoimmune diseases usually come with one or more of the following: painful joints and painful muscles. Therefore even 5 years ago most Rheumatology clinics offered narcotics to some degree to help manage pain. In 2009 when I came over to the field of Rheumatology from Emergency Medicine narcotics were extremely commonplace. I began prescribing narcotics at that time. The history of the clinic that I first worked for had at one time a single clinician devoted to pain management prescribing a variety of controlled medications a high percentage being narcotics. New patients often came with a history of taking narcotics for pain relief and other controlled medications to relax muscles and promote sleep.
From my experience with patients taking such medications led to my present conclusion that narcotics are best limited to acute episodes such as post-surgery. There may be a rare place for chronic long-term use of narcotics, but as a Rheumatology specialist, I have chosen like most Rheumatologists that long-term management of chronic pain is best managed by professionally trained clinicians in the specialty of Pain Management.
In Rheumatology today the focus is not to treat pain relief directly, but instead to treat the disease that is causing pain. The options for treatment of auto-immune diseases are immense and growing rapidly in contrast to even ten years ago. The “treat to target” approach endorsed by the American Academy of Rheumatology points toward the goal of remission or near remission of disease. So, the work in Rheumatology is to diagnose as accurately as possible and find through trials of approved medications that medication that offers the best reduction of pain, fatigue, and other symptoms. This is our focus remission of disease through positive life-style changes combined with one of our amazing, advanced medications.
Narcotics and other addictive substances are a distraction and take away from the real work that the patient and the clinician need to do to manage an autoimmune disease. Currently, I offer many options in reducing pain such as mild exercise, stress management, anxiety reduction, NSAIDs when appropriate, brief bursts of corticosteroids and others. I am always looking for more ways to reduce pain safely.
Our clinicians at BRI provide their expertise in clarifying diagnosis and developing treatment for patients with Autoimmune and Inflammatory disorders. We are not qualified by training or experience in the process of disability determination. Therefore, we do not perform these evaluations nor complete forms related to them. State and private entities that provide Independent Medical Evaluations and Physical Capacity Evaluations in the course of disability determination, however, may request our records to supplement the process of evaluation. Our records will be provided to these agencies only with patient's consent.