ii iii Prescription Drug Diversion and Pain HISTORY, POLICY, AND TREATMENT Edited by John F. Peppin, DO, FACP DIRECTOR CENTER FOR BIOETHICS, PAIN MANAGEMENT AND MEDICINE FLORHAM PARK, NEW JERSEY, NJ CLINICAL ADJUNCT PROFESSOR MARIAN UNIVERSITY, COLLEGE OF OSETOPATHIC MEDICINE INDIANAPOLIS, IN CONSULTANT HAMDEN, CT John J. Coleman, MA, MS, PhD ASSISTANT ADMINISTRATOR (RETIRED) DRUG ENFORCEMENT ADMINISTRATION FOUNDER AND PRESIDENT (RETIRED) PRESCRIPTION DRUG RESEARCH CENTER LLC CLIFTON, VA Kelly K. Dineen, RN, JD, PhD ASSISTANT PROFESSOR OF LAW DIRECTOR, HEALTH LAW PROGRAM CREIGHTON UNIVERSITY SCHOOL OF LAW OMAHA, NE Adam J. Ruggles, JD, MA ATTORNEY AND BIOETHICIST EVANSVILLE, IN 1 iv 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2018 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Names: Peppin, John F., editor. | Coleman, John J., Ph. D., editor. | Dineen, Kelly K., editor. | Ruggles, Adam J., editor. Title: Prescription drug diversion and pain: history, policy, and treatment / edited by John F. Peppin, John J. Coleman, Kelly K. Dineen, Adam J. Ruggles. Description: New York, NY : Oxford University Press, [2018] | Includes bibliographical references. Identifiers: LCCN 2018000838 | ISBN 9780199981830 (pbk.) Subjects: | MESH: Analgesics, Opioid | Chronic Pain—therapy | Drug and Narcotic Control | Prescription Drug Diversion—prevention & control | Opioid-Related Disorders—prevention & control | United States Classification: LCC RC568.O45 | NLM QV 89 | DDC 615.7/822—dc23 LC record available at https://lccn.loc.gov/2018000838 This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up- to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/o r application of any of the contents of this material. 9 8 7 6 5 4 3 2 1 Printed by WebCom, Inc., Canada v We dedicate this volume to the memory of two wonderful health professionals and human beings. This project has been plagued by sadness for most of the editors. Soon after starting this project, Dr. Howard Smith passed away suddenly. Howard was a wonderful man, dedicated to advancing the science and treatment of pain. He was gracious and was always willing to help others build their careers. He will be sorely missed. Dr. Kenneth L. Kirsh was a dear friend who spent his professional life trying to improve the lives of chronic pain patients. Soon after starting work on this volume, Ken was diagnosed with advanced cancer and was not able to continue with this project. He passed away in March 2017. He too was a wonderful person who will be missed by his friends, colleagues, family, and patients. vi vii CONTENTS Contributors ix Disclosures xi Preface xiii John F. Peppin, John J. Coleman, and Kelly K. Dineen 1. Opioid Medications: Old Wine in New Bottles 1 Timothy Atkinson, John J. Coleman, and Jeffrey Fudin 2. Legal Regulation of Prescription Opioids and Prescribers 17 Kelly K. Dineen and Adam J. Ruggles 3. Monitoring Prescriptions, Third- Party Healthcare Payers, Prescription Benefit Managers, and Private-Sector Policy Options 39 John J. Coleman 4. Whatever Happened to the Decade of Pain Control and Research? 78 John J. Coleman 5. Evaluation and Treatment of the Chronic Pain Patient: Practice and Complexity 110 John F. Peppin, Pravardhan Birthi, Bill H. McCarberg, and Yvonne D’Arcy viii 6. An Overview of the Abuse Potential of Nonopioids: Sedatives, Hypnotics, and Stimulants 136 Christopher M. Herndon and Kelly N. Gable 7. Psychiatry and Chronic Pain: An Associative Connection 152 Hani Raoul Khouzam 8. Managing Pain in Patients with a History of a Substance Use Disorder: Challenges and Opportunities 176 Martin D. Cheatle 9. Opioid Prescribing in Stigmatized and Special Populations 190 Kelly K. Dineen 10. The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse 205 Michael E. Schatman 11. Pain Management Assessment Beyond the Physician Encounter: Urine Drug Monitoring and Patient Agreements 219 Anand C. Thakur Epilogue 239 John F. Peppin, John J. Coleman, and Kelly K. Dineen Index 245 viii • Contents ix CONTRIBUTORS Timothy Atkinson, PharmD, BCPS, CPE Jeffrey Fudin, BS, PharmD, DAIPM Clinical Pharmacy Specialist, Pain FCCP, FASHP, FFSMB Management Chief Executive Officer and Chief Medical Veterans Affairs Tennessee Valley Officer, Remitigate LLC Healthcare System Delmar, NY Murfreesboro, TN Clinical Pharmacy Specialist and Director, PGY2 Pharmacy Pain Pravardhan Birthi, MD Residency (WOC) Interventional Pain and PM&R Physician Stratton VA Medical Center CHI Health Saint Francis Pain and Physical Adjunct Associate Professor of Pharmacy Medicine Clinic Practice Grand Island, NE Albany College of Pharmacy & Health Martin D. Cheatle, PhD Sciences Associate Professor Albany, NY Center for Studies of Addiction Adjunct Assistant Professor of Pharmacy Perelman School of Medicine Practice University of Pennsylvania Western New England University College Philadelphia, PA of Pharmacy Springfield, MA Yvonne D’Arcy, MS, ARNP- C, CNS, FAANP Kelly N. Gable, PharmD, BCPP Pain Management and Palliative Care Associate Professor Nurse Practitioner Southern Illinois University Edwardsville Ponte Vedra, FL School of Pharmacy Edwardsville, IL x Christopher M. Herndon, PharmD, Michael E. Schatman, PhD BCPS, CPE, FASHP Department of Public Health and Associate Professor Community Medicine Southern Illinois University Edwardsville Tufts University School of Medicine School of Pharmacy Boston, MA Edwardsville, IL Anand C. Thakur, MD Hani Raoul Khouzam, MD, MPH, FAPA CEO/ Medical Director Staff Psychiatrist ANA Pain Management Chief of Salinas Outpatient Adult Services Clinical Assistant Professor Natividad Medical Center Department of Anesthesiology Salinas, CA Wayne State University Detroit, MI Bill H. McCarberg, MD, FABPM Neighborhood Healthcare (FQHC) Elizabeth Hospice San Diego, CA x • Contributors