Complete Your CE Test Online - Click Here to other professionals or members of a pain management team. Some clinicians may be willing and able to continue a regimen of opioid therapy even after the discovery of aberrant behavior if done with intensified monitoring, patient counseling, and careful documentation of all directives. This level of vigilance and risk management, however, may exceed the abilities and resources of the average prescriber. In such cases, referral to a provider with specialized skills or experience in dealing with high-risk patients may be prudent. Patient education about controlled substances Responsible prescribing of controlled substances requires clinicians to fully educate patients about the many issues related to safe use, storage, and disposal of such substances due to their potential for misuse or abuse. Not only will educating patients possibly improve their adherence to the medication regimen, it may prevent accidental overdose or inadvertent diversion to non-authorized users. Education about safe use, storage, and disposal should be part of every provider-patient interaction involving these substances. This education may include verbal instructions delivered by a prescriber, nurse or other trained clinic staff person, written handouts, guidance through other media (such as CD, DVD, or the Internet), or referral to other resources (such as a local clinic webpage or national resources). Patients should be instructed about the proper use and administration of any prescribed controlled substances, including special directions about timing of doses, whether to administer the medication with or without food, and any foods or other medications to avoid while administering [33]. Here are some other key ideas to convey to patients about proper use: ● ● Read the prescription container label each time to check dosage. ● ● Never use medicines after the expiration date. ● ● Never share medicines with others. ● ● Do not take medication with alcohol or other sedatives. ● ● Do not take a medicine to promote sleep (unless it has been specifically prescribed for that use). ● ● Never break, chew, or crush medicines. ● ● Transdermal products may be affected by external heat, fever, and exertion, which can increase absorption of a medication, leading to a potentially fatal overdose. In addition, transdermal products with metal foil backings are not safe for use in MRI scanners. Patients should be continually reminded that sharing, selling, or giving away opioids is against the law and poses significant hazards not just to the recipient of the medications, but also to society at large. Physicians must also educate patients about the importance of proper storage of controlled substances. It is best if all controlled substances are stored in a locked cabinet or other secure storage unit. Storage areas should be cool, dry, and out of direct sunlight. Remind patients not to store medications in their car, to keep medications in the original containers, and to avoid storing medications in the refrigerator or freezer unless specifically directed to do so by a health care provider or pharmacist. Patients, family members, or caregivers should also monitor pill containers so they will know if any pills are missing. Proper disposal of unused controlled substances is also important. Instruct patients to follow the instructions of a pharmacist for disposal or to mix the medicines with an undesirable substance, such as used coffee grounds or cat litter, put the mixture into a disposable container with a lid or a sealable bag, and place it in the trash. The DEA also sponsors the National Take Back Initiative, which coordinates periodic controlled substance take-back programs at thousands of state and local law enforcement agencies across the country. More information about these programs can be found at: drug_disposal/takeback/index.html Nursing consideration: Nurses are often the healthcare professionals who provide the most detailed patient/family education. They must be current in knowledge of drug abuse and make sure that the patient/ family education they provide is accurate. They must also assess patient/family knowledge acquisition of all facets of education. Conclusion Clearly, the rise of prescription drug abuse, and the wider use of controlled substances, is related to social, cultural, and economic forces both larger and more powerful than any role that clinicians have in their day-to-day work with controlled substances [35]. 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