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10 Articles in Volume 17, Issue #10
A Guest Editorial on Counterfeit Pain Medication: The Other Epidemic
A Model to Incorporate Functional Medicine into Chronic Pain Care
Chronic Pain and Substance-Related Disorders
Getting at the Root of Opioid-Induced Constipation (OIC) with an Osteopathic Approach
Inside FDA's Guidance on Generic Abuse-Deterrent Opioids
Neural Pathway Pain — A Call for More Accurate Diagnoses
Pain Care in a Natural Disaster
Pharmacological Interventions in Sport-Related Concussion
The Internet of Medical Things
What Type of Withdrawal Symptoms from Tramadol Might a Patient Experience?

Pain Care in a Natural Disaster

How providers and clinics can prepare for a pending superstorm to ensure patients receive the care they need

When natural disasters strike, healthcare providers may face power outages, inaccessibility, and evacuations that make it difficult to help patients in need. For those providing regular pain care or addiction treatment, the consequences of missed medication or appointments can be serious. In light of the recent hurricanes affecting a large portion of the United States, as well as the catastrophic fires on the west coast, this article provides a look at how pain practitioners, in particular, can prepare for such situations.

Collaborate on Clinic Guest-Dosing

Pain centers and their patients may be able to rely on guest-dosing (ie, when one clinic provides medication to a patient from another clinic) when a superstorm hits. When Hurricane Harvey touched ground in Texas in September, Farrukh Shamsi, director of the Texas Clinic, a methadone clinic in Houston, said that having a disaster plan in place before the storm struck paid off. By cooperating with clinics around the state, the Texas Clinic was able to stay open throughout the bad weather and guest-dosed patients from other evacuated clinics; some of the patients waded through five miles of floodwater to get their dose, shared Shamsi.

The staff at the Texas Clinic communicated in advance with clinics in other cities, where the hurricane was expected to hit hardest. They set up a medication-dispensing schedule so that the evacuated patients could be dosed at their site.

Harshal Kirane, MD, director of addiction services at Staten Island University Hospital in New York, also has utilized guest-dosing in the midst of a natural disaster. He was working at Bellevue Hospital in Manhattan during Superstorm Sandy in 2012 and recalled how the hospital had to be evacuated, affecting a number of outpatient services. “We had many folks on maintenance regimens with controlled substances,” he said.

“We needed to make arrangements for these patients so that they could be guest-dosed at other clinics,” said Dr. Kirane. “One of the fundamental dilemmas with medicines that are controlled substances [Schedule 3] is the need to respect the treatment needs and autonomy of patients while also setting limits so that these patients aren’t vulnerable to relapse or misuse of medications.”

Robert Duarte, MD, director of the Pain Center at the Neuroscience Institute at Northwell Health in Great Neck, New York, and president of the New York State Pain Society, said  “Hospital pharmacies may be able to provide a limited emergency supply with a prescription to patients.” When his pain center faced Superstorm Sandy, he recalled that it was difficult to ensure that patients taking opiates for pain, whether chronic back pain, cancer pain, or post-surgical pain, got their medications. In some instances, sending a prescription to a hospital that could provide the medication for them was a useful alternative.

“A hospital may be able to create special services or find a temporary outpatient clinic that could provide medications,” added Dr. Kirane. “If there is an unavoidable interruption of services, patients may be given their medications a few days in advance.”

Advise All Parties in Advance

Shamsi recalled that his clinic also worked to contact patients before the storm to alert them that the office would remain open in case any questions arose. Providing advance notice is clearly not possible in the event of an earthquake or tsunami, Dr. Kirane said, but there is generally some lead time before a hurricane. “Providers may be able to coordinate services in the extended network and throughout the community.”

Providers should also ensure that all of their staff members, including any operators or doctors on call, are aware of the emergency plan so that they can effectively communicate with patients who call in. Letting patients know about guest-dosing locations, outpatient hospital options, and pharmacies that may be able provide a three- to five-day emergency supply may ease any potential panic, Dr. Duarte said.

Finally, signs may be posted to any external clinic or practice doors to notify patients of where they can go or whom they can call, if needed. If a provider utilizes social media, the same information may be posted.

Offer Patients an Emergency Toolkit

Whether in preparation for a pending superstorm, or even long-term travel, healthcare providers may choose to offer their patients a few tips regarding their pain prescriptions. For example, patients should be advised to keep with them a list of their medications, including dosage information, as well as their providers’ names and contact details. They should also be educated about potential contamination of prescription products during a flood.

Pain practitioners may further recommend that their patients keep an emergency kit containing essential pain care items, advised Dr. Kirane. For instance, this kit may include medical device batteries and chargers, a backup belt or brace if used, and any extra medications, if available.

-Reported by Rosemary Black

Last updated on: December 7, 2017
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