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Opioids Clinical Primer

This six-part program provides an overview of key concepts and skills for clinicians facing common challenges in the management of patients with chronic pain, including reducing the risks of opioids and addressing opioid use disorder.

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challenges working as locum

 it is challending to address issues around narcotic when doing locum at times. Specially if patients are used to a  routine set by their own doctor  that I may not be comfortable following . any Advise thank

4 Replies

  • How long are your locums for? If they are a month or less, you could ask the physician to do prescriptions that cover the period of time that you are there. When I go on vacation, I give my patients an extra few weeks of meds so that the locum does not have to deal with it. If your locums are several months long, I think you should discuss a plan in advance that you are comfortable with the physician. It is reasonably easy for the doc to do an EMR search of all their patients who are on chronic opioids and discuss a plan with you that you are both comfortable with.
  • I keep a list of my chronic narcotic patients, specifically the "legacy" ones from back when opioids were the cure-all for everything. I try to ensure that I've sent in refills before I leave.
    When I cover for others, I will usually check the chart to ensure this is a chronic med and being asked for on schedule and then give enough to cover the patient until the primary physician returns
  • In reply to michaelschweitzer:

    Thank you very much very helpful tips for me being new to locum practice,

    The area I was doing locum was known for drug diversion in Ontario. I had a few requests of early refills.I ended up refilling for short time but deep inside I felt uncomfortable .

    I realized It is easier for me to confront and investigate requests for early refill when patients are in my own practice and I have a contract with them but I realized it is much more difficult to do so when I am covering another doctor, something I have to work on.
    I appreciate if any one have a good strategy of communicating early refill policy with patients who are new to a locum doctor.

    Thanks again
  • In reply to mozhdehmottaghian:

    Most patients should have a narcotic contact that says that early refills will not be filled. I would be cautious about doing a locum for someone who does not have narcotic contracts or a clear policy. In my own practice, if a patient requesting early refill that I think might be legit (sometimes for lost meds associated with travel, or an intercurrent painful condition like surgery) and I am not concerned about diversion, I decrease the dispensing interval. So I would put them down to weekly or twice weekly dispensing. I think the most important thing is to discuss all this with the physician you are doing the locum for.