If opioid analgesics have been used or are being considered, dependence and addiction risk should be assessed through careful personal and family history, review of outside records and assessment of illicit or prescription medication misuse. Check your State’s prescription monitoring program (PMP) and perform a urine screen by combination of enzyme immunolinked assay (EIA) and gas chromatography/mass spectroscopy (GCMS) prior to prescribing and at least yearly for patients given chronic opioid therapy. [ID]*
If initiating opioid therapy:
Assess risk for addiction (see Table 3)
Present opioids as a tool to help reach functional improvement goals; be clear that opioids will be continued only if they
contribute to functional improvement or maintenance
Establish prescribing practices: one prescriber/one pharmacy, no after-hours refills, no early refills without appointment,
compliance with adjuvant therapies, no Emergency Department visits for pain medications, random urine drug screens, required follow-up at scheduled intervals. See model “Controlled Substance Treatment Agreement” in Appendix C.
Assess risk for addiction (see Table 3)
Present opioids as a tool to help reach functional improvement goals; be clear that opioids will be continued only if they
contribute to functional improvement or maintenance
Establish prescribing practices: one prescriber/one pharmacy, no after-hours refills, no early refills without appointment,
compliance with adjuvant therapies, no Emergency Department visits for pain medications, random urine drug screens, required follow-up at scheduled intervals. See model “Controlled Substance Treatment Agreement” in Appendix C.
For patients being considered for, or already receiving, chronic daily opioid therapy: check comprehensive drug screen = EIA + GCMS (at UM = DRUG COMP = Drug6 (i.e. EIA) + GCMS) and search State prescription monitoring programs (PMP) for opioid prescriptions (e.g., MAPS search in Michigan [https://sso.state.mi.us], OARRS in Ohio [www.ohiopmp.gov]).