21-360 Surgery and Pain Management in Patients with Opioid Use Disorder
Date: 05/18/21
Reminder to continue use of Suboxone® prior to surgery
The California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) Integrated Substance Use Disorder Treatment (ISUDT) Program leadership requests that the following information is shared with providers contracted with the Prison Health Care Provider Network (PHCPN).
Manage effective pain control
CDCR patients who are on medication-assisted therapy (MAT) for substance use disorder (SUD) or opioid use disorder (OUD) are monitored for their participation in the ISUDT Program. Because patients with OUD require higher opioid dosages to manage their surgical pain, advance planning is needed for effective pain control for CDCR patients who are scheduled for surgery.
Keep the referring institution informed
It is important to keep the referring institution informed in the management plan from admission to discharge. These individuals (or designees) from the referring institution should be included in the management plan:
- Health Care Manager (HCM)
- Chief Medical Officer (CMO)
- Chief Executive Officer (CEO)
- Chief Physicians/Surgeon (CPS)
NOTE: Hospitalists do not need to request X-waivers to continue Suboxone when CDCR patients are admitted.
After surgery discharge planning
Discharging a CDCR patient to the institution setting requires multiple steps, including:
- acquiring a medical bed
- assembling a transportation team
- procuring medications and durable medical equipment
When possible, discharge the CDCR patient before noon to ensure this coordination is done safely.
When communicating medical issues and plans of care to CDCR patients, providers should emphasize that they have made written recommendations to the prison’s medical staff for follow-up care that are subject to review by prison clinicians.
Learn more about pain management and OUD or SUD
For more information about pain management in CDCR patients with OUD and a guide to substance use disorder, refer to these resources:
- California Society of Addiction Medicine (CSAM) guidelines -Chapter 3, Managing Pain in Patients with Opioid Use Disorder Guidelines for Physicians Working in California Opioid Treatment Programs (PDF).
- California Corrections Health Care Services (CCHCS) Substance Use Disorder Care Guide (PDF).
Additional information
If you have questions regarding the information contained in this update, contact the PHCPN Provider Services Center by email at Prison Network Support within 60 days or by telephone at 877-899-0561.