RE: [EXTERNAL] re:Opioid dependence
This is from an article I sent to clinical staff here last February in my newsletter. I hope it helps answer your question.
Frequently “use” of substances such as alcohol or tobacco are documented, but the question be is there an issue of dependence instead of casual use?
Dependence can be defined as a presence of at least three of the following seven elements in the past 12 months:
· Tolerance
· Withdrawal
· Used in larger amounts or over a longer period than intended
· The user has a persistent desire or makes unsuccessful attempts to cut down on the substance in question
· A great deal of time is spent in obtaining or using the substance (e.g. chain smoking)
· A reduction in activities because of substance use
· Recurrent use of the substance continues despite recurrent physical or psychological problems
Again, as the patients provider the final call is up to you. But to support
continuity of care and accurately document the patient’s health status consider
the above when documenting a patients pattern of substance use.
Based on the description you provide for chronic pain management, and the VA is one of the leaders in that with many Veterans with chronic pain issues, I don’t think your patients meet the criteria for dependence or abuse. Use is a better descriptor in this case.
Robert
Robert S. Hodges MSN, BSN, RN, CCDS, VHA-CM
Clinical Documentation Improvement Specialist
Secretary, Nursing Professional Standards Board
Aleda E. Lutz VA Medical Center
1500 Weiss Street, ATTN PAS-136
Saginaw MI 48602
989-497-2500 x13101
Robert.Hodges2@va.gov
VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
Frequently “use” of substances such as alcohol or tobacco are documented, but the question be is there an issue of dependence instead of casual use?
Dependence can be defined as a presence of at least three of the following seven elements in the past 12 months:
· Tolerance
· Withdrawal
· Used in larger amounts or over a longer period than intended
· The user has a persistent desire or makes unsuccessful attempts to cut down on the substance in question
· A great deal of time is spent in obtaining or using the substance (e.g. chain smoking)
· A reduction in activities because of substance use
· Recurrent use of the substance continues despite recurrent physical or psychological problems
Again, as the patients provider the final call is up to you. But to support
continuity of care and accurately document the patient’s health status consider
the above when documenting a patients pattern of substance use.
Based on the description you provide for chronic pain management, and the VA is one of the leaders in that with many Veterans with chronic pain issues, I don’t think your patients meet the criteria for dependence or abuse. Use is a better descriptor in this case.
Robert
Robert S. Hodges MSN, BSN, RN, CCDS, VHA-CM
Clinical Documentation Improvement Specialist
Secretary, Nursing Professional Standards Board
Aleda E. Lutz VA Medical Center
1500 Weiss Street, ATTN PAS-136
Saginaw MI 48602
989-497-2500 x13101
Robert.Hodges2@va.gov
VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens