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Part 2 – Behavioral health resources available for assessment and treatment of opioid misuse and abuse*

Pain management is a complex issue for many primary care physicians (PCP). Generally, PCPs are able to identify opioid abuse, but opioid misuse is more difficult to pinpoint – especially in those patients with chronic pain.¹

Independence and Magellan Healthcare, Inc. (Magellan), an independent company, are aware that opioid management is a current and relevant problem for PCPs. As such, we are collaborating to provide resources for the assessment and management of opioid misuse and abuse. The Chabal 5-Point Prescription Opiate Abuse Checklist includes questions you may have already incorporated into your daily practice. This checklist is a reliable and valid tool. Three positive responses alert you to possible abuse of prescription opiates.²

The National Institute on Drug Abuse³ (NIDA), a subdivision of the National Institutes of Health (NIH), provides resource tools for screening patients for opiate misuse and abuse. Two such aids include:

• NIDA Drug Use Screening Tool. This online screening tool assists providers in identifying risk of substance abuse and resources in patient care and support.
• CAGE-AID assessment tool. The CAGE-AID assessment tool is similar to the CAGE assessment tool for alcoholism, but adapted to assess for other substance use.

You also can check an opioid database (state-based databases with information on patients with opioid prescriptions that provide patient-specific data on frequency, dose, and name of medication as well as a list of prescribing practitioners) for patterns in member prescriptions and opioid use.

Additionally, the NIDA has a variety of assessment tools and questionnaires that patients can complete before they see their PCP. This is especially helpful if completed by new patients or patients requiring pain management for the first time. These self-reported questionnaires provide valuable information about patient history and behaviors that can contribute to opioid abuse. During the course of treatment, the PCP can re-evaluate the patient and implement strategies to more effectively manage these behaviors while providing pain management. You can access screening tools and other resources via the NIDA website.

Magellan can assist with getting your patient the right services

The relationship the PCP has with his or her patient with chronic pain is valuable; this relationship creates a strong base to facilitate an open discussion as well as help solve issues. As concerns arise, you may want to start a discussion with your patient about your observations and alternatives for pain management. This may be a difficult conversation to initiate because of the social stigma of abuse and addiction attached to prescription pain medication as well as the patient's own perceptions of pain and medication use.

Fortunately, there are behavioral health providers available who can assist with your concerns about your patients' behaviors. Magellan is available to assist in matching the patient with the right behavioral health provider.

If you identify possible opioid abuse or misuse, you can:

• Encourage the patient to call the number on the back of their medical ID card to arrange a referral to a behavioral health provider. A Plan staff member will work with the member to determine the most appropriate resource based on patient need and preference, provider specialty, and provider location, as well as other specific patient requests or considerations.
• Contact Magellan directly (with patient permission) to request assistance with connecting the patient to the appropriate behavioral health provider.

Magellan's Behavioral Health Disorders Toolkit

Magellan also offers access to a variety of collaborative behavioral health materials, including substance use resources, through Magellan's Behavioral Health Disorders Toolkit. Organized by category, the materials are designed to give medical practitioners the information and screening tools needed to assist in making behavioral health referrals. You can access Magellan's Behavioral Health Disorders Toolkit, including information on CAGE and CAGE-AID screening, via our Providers webpage or on the NaviNet^® web portal in the Administrative Tools & Resources section under Health and Wellness.

Working together

We are committed to promoting integration of medical and behavioral health services toward the goal of better overall outcomes for patients and encourage you to access these resources.

Remember, you don't have to do this alone. Collaboration with a behavioral health provider can enhance the treatment regimen that you and your patient are developing to manage pain.

* These guidelines are not intended to replace a practitioner's clinical judgment. They are designed to provide information and to assist practitioners with decisions regarding care. The guidelines are not intended to define a standard of care or exclusive course of treatment. Health care practitioners using these guidelines are responsible for considering their patients' particular situation in evaluating the appropriateness of these guidelines. This information is not a statement of benefits. Benefits may vary and individual coverage must be verified.

¹ Hartrick, C, Gatchel, R & Conroy, S. (2012). "Identification and management of pain medication abuse and misuse: current state and future directions," Expert Review of Neurotherapeutics, 12:5, 601-610, DOI: 10.1586/ern 12_34.

² Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E. (1997) "Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors," Clinical Journal of Pain, Jun: 13(2): 150-155.

³National Institute on Drug Abuse: www.drugabuse.gov/publications

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most Independence members.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

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