ASSESSING PATIENTS ON OPIOIDS
Clinicians should work with patients to establish pain treatment goals and check for improvements in pain and function regularly. Prescribers should taper or reduce dosage and discontinue opioids if a patient experiences more harms than benefits on opioid therapy. Tapering plans should be individualized. Suggested taper plans include a 10% decrease from the original dose per week or month, monitoring for withdrawal symptoms (drug craving, anxiety, insomnia, abdominal pain, vomiting, diarrhea, and tremors) with psychosocial and specialty support. Consult an addiction medicine specialist (as appropriate) to help support taper management.
OPIOID USE DISORDER & OVERDOSE RISK
Opioid use disorder, also referred to as addiction or dependence, is a medical condition that characterizes the compulsive use of opioids despite negative health and social consequences of continued use.
It is vital for clinicians to screen for substance use disorders among patients who are taking opioids and other drugs. Symptoms of opioid use disorder include strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.
Clinicians can initially screen their patients for substance use disorders by asking “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” Other validated screening tools can be found at NIDAMED Screening Tools for Adults and Adolescents.