Tennant Blood Study—Summary Report
by Forest Tennant
 For some time, the medical staff of Practical Pain Management have
been aware of the fact that there is a dire need for a method of measuring the
effectiveness, tolerance, and proper usage of prescribed opioids, and other aggressive
drug therapies. To claim wrongdoing by pain physicians, arbitrary guidelines have been
employed by prosecutors, litigants, and medical boards ranging from the total number of
pills prescribed, the number of prescriptions, or blood levels to establish
legality—all without consideration of the patient’s condition.
As a result, physicians are inhibited from properly prescribing opioids to chronic pain
patients, stand the risk of prosecution and, in general, are unable to adequately fulfill
their obligations to their patients.
The author has believed that a correlation between blood level concentrations and
proper prescribing could be developed. To do this, Practical Pain Management
solicited readers in December 2005, to participate in a survey in which they would submit
blood level concentrations and select conditions of patients. The following sections
describe the methodology, patient descriptions, major problems addressed, results, and
conclusions. Ultimately, it is a goal of this publication to develop guidelines that will
protect physicians and permit them to minister to their patients to their fullest ability.
Goals for this Survey
This survey was undertaken to accomplish specific goals which are stated below:
1. To prevent the arbitrary application of published, therapeutic opioid blood levels in
non-tolerant patients with acute or short term conditions (e.g. post operative or dental;
see Table 1) to chronic pain patients who are tolerant and treated with high opioid
dosages.
2. To prevent claims of over-prescribing by physicians based solely on an opioid blood
level in situations where the patient has had an accident or has died.
3. To encourage physicians to use blood levels to help determine if opioid dosage is
appropriate or if malabsorption or rapid metabolism may be present.
4. To encourage the use of opioid blood levels to help determine if tolerance to opioids
is present (normal physiologic and mental function in the presence of a significant opioid
blood level is diagnostic of opioid tolerance.)
Please refer to the March 2006 issue for the complete text. In the event you need to
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— March 2006
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