Opioid abuse epidemic continues among U.S. adults

Research from the 2003-2013 National Surveys on Drug Use and Health recently published in The Journal of the American Medical Association indicates that while non-medical use of prescription opioids has decreased slightly in recent years, the incidence of disorders related to opioid use, as well as frequency of use, and related mortality have increased among U.S. adults ages 18-64. Other research from the Centers for Disease Control, published in 2011, shows that the non-medical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct healthcare costs. What can be done to stem this tide of rising opioid abuse and healthcare costs? Integrative healthcare has proven to be a useful tool in treating chronic pain and controlling healthcare costs. Click here to read the latest CHP white paper “The Cost of Chronic Pain: How Complementary and Alternative Medicine Can Provide Relief.”

Anti-depressants, opiate and non-opiate analgesics linked to increased homicide risk

In a report published online in World Psychiatry on June 11, 2015, research shows a link between impulse control and increased homicide risk with use of anti-depressants, opiates and non-opiates, including benzodiazepines. The study found no link with prescription anti-psychotics and decreased impulse/homicide risk. “The surprisingly high risk associated with opioid and non-opioid analgesics deserves further attention in the treatment of pain among individuals with a criminal history,” the authors write.Providers should inquire and note these medications as well as past criminal behavior.

Copyright, trademarks, and patents, oh my!

You’ve started your own practice – congratulations! You have a logo, a practice name, new stationery and business cards, Facebook and Yelp pages, and a beautiful new brochure all about what you can offer patients to leave around town. You’ve even invented a widget! You are ready to bring in new business! Or are you? Are your protecting your business with an appropriate copyright, patent, or trademark? Not sure if you need one? If this describes you, keep reading.

What is a copyright?

A copyright is defined as the “the exclusive legal right, given to an originator or an assignee to print, publish, perform, film, or record literary, artistic, or musical material, and to authorize others to do the same.” Simply put, a copyright is a mark or notice on a work, generally artistic or literary, that notifies the public who it belongs to. For example, photographers copyright images they’ve produced and books are copyrighted by authors. The copyright serves as notice to the general public that the work, whatever its medium, belongs to the person that created it and no one can do anything with it unless the creator of it gives them consent. The United States Copyright Office has an extensive FAQ on copyright, what it protects, if registration is needed and more.

What is a trademark?

A trademark is “a symbol, word, or words legally registered or established by use as representing a company or product”. Most often, business will use a trademark to protect a brand name, their business name, or logo. In the United States, trademarks are registered with The United States Patent and Trademark Office (USPTO). The USPTO has an excellent series of videos on trademarks as well a booklet on basic trademark facts. There are many regulations surrounding the registration of a trademark; your legal counsel may be able to advise you if a trademark is needed and whether a trademark attorney needs to be involved.

What is a patent?

A patent is “a government authority or license conferring a right or title for a set period, especially the sole right to exclude others from making, using, or selling an invention”. You may need a patent if you’ve invented something that you want to sell and do not want others to be able to copy and market your invention as their own. As with trademarks, applying for a patent can be a complicated process and a patent attorney may need to be involved.

Which do I need?

It depends on what you need to protect. If your logo meets the requirements for legal registration you may consider protecting it with a trademark. If the widget you invented is something you want to produce and sell, consider a patent. And if you’re authoring original works of artistic merit (which includes computer software), a copyright may be needed. Note that a copyright does not protect facts, ideas, systems, or methods of operation. For example, you couldn’t copyright the method of diagnosing a subluxation, but a copyright may protect the way you present that method such as in a brochure for the public or a video that you create to post on your website. When considering trademarks and patents, you may wish to consult your legal counsel.

More info is available for a variety of US government sources including:

The Small Business Administration

The United States Patent and Trademark Office

StopFakes.gov – Information on how to protect intellectual property

The CHP Group does not provide legal advice. Nothing in this post should be construed as legal counsel or advice. Please consult with a licensed attorney for your specific situation.


Sugar-sweetened beverages linked to a variety of ills

High fructose corn syrup has now been linked with a variety of ills including, but not limited to, diabetes, heart disease, obesity and gout. One of the highest measured sources of intake are beverages such as sodas and artificially flavored beverages; rated as high as 50% of consumption! The WHO (World Health Organization) suggests limiting content to no more than 10% of total energy intake or 12 tsp of sugar. One soda has 12 tsp of sugar, so patients drinking one soda per day will reach a maximum limit without adding any other source of sugar. Providers can help patients reduce the risk of acquiring diabetes, gout and other disease states by addressing dietary questions on an intake form that question sugar intake.

Preventing physician/provider burn-out: knowledge is power

In a 2013 survey conducted by the Mayo Clinic’s Department of Internal Medicine (Rochester, MN) more than half of the physicians surveyed reported increasing stress associated with symptoms such as suicide ideation, depression, and burnout. Often when this type of information and statistics affect patient safety, swift action is taken; however, with physician symptoms, we appear to be slow to respond. This begs the questions, how are you dealing with the stress of private practice? Do you have coping mechanisms? Can you identify the areas of practice causing greatest stress? What can you do about those areas for your own personal health?

Simply recognizing burn-out can prevent potential problems. When a provider is ‘weakened’ by the stresses of life, there may be a greater risk of seeking stress relief with patient interactions, drugs/alcohol, or other unprofessional conduct – all of which could lead to serious personal and professional problems. If you recognize signs of burn-out, consider seeking help from a trained mental health professional. The American Association of Family Practitioners published a article in the April 2002 issue that also included suggestions like seeking out a support group and trying to avoid cynicism. For more information on ideas for managing work-related stress, try these links:

KevinMD.com – http://www.kevinmd.com/blog/2012/11/recognize-manage-physician-stress-burnout.html

AMA – http://journalofethics.ama-assn.org/2003/09/pfor1-0309.html

Journal of Medical Practice Management – https://www.med.upenn.edu/gastro/documents/Sotile.pdf

Gabapentin: Anti-seizure medication used off-label for nerve pain

When reviewing new or established patient intake forms, medication knowledge matters. Many providers are familiar with hydrocodone, anti-inflammatories, and muscle relaxers for spine pain that radiates. However, a relatively new drug, gabapentin, is now used with more frequency. Clicking on the link below will provide you with valuable information on uses and side effects in order to better recognize patient symptoms that could signal serious complications with the medication.


What is massage therapy informed consent?

Best practices in every field of the healing arts now highly suggest the use of a signed “PARQ” or Informed Consent form. This acronym describes the necessary elements that should be included to inform a client or medical massage patient about the services rendered. The form should include, at a minimum, these elements:

  • P = Procedure(s). Use clear language to describe the types of massage to be used on patients.
  • A = Alternatives. List any alternatives to massage.
  • R = Risks. Describe any risks the patient may be subject to.
  • Q = Questions. Allow time for the client or medical massage patient to ask questions.

Massage therapists are not exempt from documenting PARQ. (See OBMT website for more information.) The following text is an example of the wording on a best practice informed consent form used at the last CHP Charting for Massage Therapists seminar.

(Provider & Clinic Name)
(Clinical or Practic Physical Address)

I hereby consent for my therapist to treat me with massage therapy after assessment, examination, and explanation of techniques recommended. I acknowledge the therapist is not a physician and does not diagnose illness or disease or any other physical or mental disorder. I clearly understand massage is not a substitute for a medical examination. I understand there are other options I may seek if massage doesn’t solve my needs. I understand no assurances or guarantees have been made to me as to the results of this treatment. I understand that as with any treatment there may be risks. Any risks have been explained to me. I assume responsibility for those risks. I understand that the massage therapist must be fully aware of any existing medical conditions. I have completed my health intake form accurately. I also agree to keep the therapist apprised of any new conditions or medications. I authorize my therapist to release or obtain information pertaining to my condition(s) and/or treatment to/from other medical providers or third party payers. I have been given time to ask questions about massage treatment.

Patient/Client Signature & Date
Patient/Client Printed Name

After, “Any risks have been explained to me,” a massage provider may choose to add: “Risks of massage may include, but are not limited to: skin irritation from scented oils and temporary pain from prolonged positions and deep pressure. Please inform the therapist if you have sensitive skin, require more or less pressure during the treatment, or if you need extra padding or pillows on the table for comfort.”

For more information on the concept of informed consent, please searching “medical informed consent” via your favorite search engine.

Help for Alzheimer’s patients with omega-3 fatty acids supplementation

Alzheimer’s disease is one of the most difficult diagnoses to manage. In a study published in May 2015, omega-3 fatty acids are shown to add cognitive flexibility in this population, which can bring much needed hope to its victims and their caregivers. This 40-patient study with controls, followed healthy adults with genetic markers for the disease. Outcomes may be an indication of a neuro-protective effect when omega-3 fatty acids are added to the diet. Findings show improved cognitive flexibility in later stages; as well as delayed onset with genetic markers. Providers with patients who have the genetic markers may consider adding this supplement before symptoms appear, as well as dosing to improve patients in later stages of diagnosis.

New professional conduct rules for Washington state LAc, LMP

New “Professional Conduct” rules were effective December 2015 for Washington state massage practitioners and acupuncturists. These new regulations are a big change from past regulations. Most of the changes have to do with dating clients/patients. However, the conduct is qualified by stating:

Sexual misconduct includes but is not limited to:

  • Suggesting the possibility of dating, sexual or romantic relationship after the professional relationship ends.
  • Terminating a professional relationship for the purpose of dating or sexual activity with patient/client.
  • Sexually demeaning behavior including verbal or physical contact, reasonably interpreted as humiliating, embarrassing or threatening.
  • A health care provider shall not engage in any activity previously listed, with a former patient/client or key party within two years after the provider-patient relationship ends.
  • Two years after patient-provider relationship is terminated, the provider shall not engage in a relationship if there is likelihood the patient will return to care with the provider or there is an imbalance of power, influence, or special knowledge.
  • Patient initiation or consent does not excuse or negate provider’s responsibility.

Please contact your licensing board with any specific questions regarding these new rules.