TY  - CHAP
M1  - Book, Section
TI  -  Clinical Negotiation and Controlled Substances
A1  - Henry, Stephen G.
A2  - Kravitz, Richard L.
A2  - Street, Richard L.
Y1  - 2021
N1  - 
T2  - Understanding Clinical Negotiation
AB  - Clinical  Take-AwaysControlled  substances  (opioids,  sedative-hypnotics,  stimulants,  and  testosterone  replacement  therapy)  are  defined  legally,  not  medically.  Most  have  the  potential  for  addiction,  serious  side  effects,  or  both.Many  clinicians  worry  that  encounters  with  patients  taking  opioids  for  chronic  pain  will  be  conflict-ridden.  In  reality,  most  such  patients  defer  to  clinicians’  recommendations  for  pain  management,  agree  with  clinicians’  treatment  recommendations,  and  try  to  be  responsible  users  of  pain  medicines.The  approach  to  the  clinical  negotiation  is  different  for  opioid-naïve  patients  requiring  treatment  for  severe  acute  pain  (limit  the  treatment  course);  patients  on  long-term  opioids  for  chronic  pain  (focus  on  functional  goals);  and  patients  who  exhibit  signs  of  a  substance  use  disorder  (taper  opioids  and  refer  for  SUD  treatment).In  negotiating  with  patients  taking  other  (nonopioid)  controlled  substances,  the  governing  principles  are  to  do  a  good  intake  exam;  inform  the  patient  about  risks  and  benefits  of  treatment;  and  monitor  the  patient’s  progress  closely.Clinicians  should:Be  mindful  of  their  own  emotions,  attitudes,  and  prejudices  when  providing  care  to  patients  using  controlled  substances.Show  that  they  take  the  patient’s  distress  seriously  through  careful  history-taking,  elicitation  of  the  patient’s  perspective,  and  empathic  statements.Assess  the  patient’s  risk  for  harms  related  to  controlled  substance  use.Work  collaboratively  to  establish  treatment  goals.Develop  a  goal-directed  treatment  plan  that  emphasizes  functional  progress  rather  than  pill-counting.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1181983580
ER  -