IMPORTANT INFORMATION REGARDING PAIN MEDICATION MANAGEMENT: New Opioid Guidelines


A message from The Internal Medicine Clinic about what Madigan is doing in the fight against our nation's opioid crisis.

Madigan's Internal Medicine Clinic is dedicated to the health and well-being of you, our patients. As you may know, our nation is currently in an opioid crisis with approximately 115 people in the United States dying of opioid overdose daily. In 2017, the Centers for Disease Control and Prevention (CDC) and the VA/Department of Defense updated guidelines for prescribing opiates. In accordance with the Department of Defense and the CDC, new policies for Madigan's Internal Medicine Clinic have begun.

The following policies outline our new opioid guidelines: To better serve you, there will now be a single refill line for all opioid refill requests. The number is: (253) 968-0701 - Please call ALL opioid refills into this phone number; our nurses will no longer be your primary contact for opioid prescriptions. Our Chronic Pain Coordinator (CPC) will assist you in getting refills and contact your nurse with any questions. Prescription refills need to be called in at least 3 business days prior to filling prescriptions.

  • Refills are now only dispensed by ONE institution or provider. We will require all patients to re-sign a pain treatment agreement with the Internal Medicine Clinic at Madigan to continue obtaining pain medication prescriptions or refills from our providers. This is a generalized agreement for the entire clinic and once signed, any of our physicians within the Internal Medicine Clinic will be able to fill your prescriptions.

  • Our CPC will assist you in obtaining a face-to-face appointment with your PCM every 6 months minimum, however, it is ultimately the patient's responsibility to schedule. Not doing so could result in running short on your current medication. Early refills will not be given.

  • You must be seen in person if you are requesting an increase or change in your prescription. As lost prescriptions may not be replaced, please be careful with your opioids. In addition, if your prescription is stolen, a police report must be filed and a copy will need to be brought into clinic.

  • Please note, per CDC guidelines, that you will be asked to submit to random drug screens. Medications cannot be dispensed before tests are completed. If illegal substances are detected, including cannabis, prescriptions may be terminated.

  • Pain medications are to be taken as prescribed. Never "self-adjust" therapy. It will be important for you to stay in communication with your provider.

  • In accordance with guidelines, we will only prescribe a maximum of 50 morphine milligram equivalents (with the exception of special circumstances or extreme cases) within our clinic. Your PCM along with your CPC will work with you to help optimize your pain regimen.

  • You may be expected to use other medical treatments (such as physical therapy or non-opioid prescriptions) to improve your pain or to adjust your regimen for your safety if needed. It may not be possible to completely remove all of your pain, but we will work with you to try to return functionality and improve your condition and quality of life. The main goal of Madigan’s Internal Medicine Clinic is to provide the best medical care for our patients.

Our staff understands that pain relief is crucial when someone is hurting. While it is OK to use short-acting pain medications (such as hydrocodone or oxycodone) for short-lived pain (such as from an acute injury), it is not beneficial to use opioids regularly to treat long-term chronic pain. It may work for a short while, but eventually the body will develop a tolerance, requiring higher doses to get the same level of relief, which may lead to requiring extremely high doses which can be very dangerous. Inappropriate pain medication management may lead to serious harm and even death.

These guidelines are being adhered to for your safety. We will ensure the Internal Medicine Clinic at Madigan is doing its best to follow chronic pain guidelines while providing you with the best possible health care.

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