#PainStopsHere

Clinic Hours : Mon-Thurs 8am-5pm, Fri 8am-12pm   Phone : (254) 245-9175    Fax : (254) 213-7771

Checklist for Prescribing Opioids

Checklist for Prescribing Opioids

History

  • Current specific pain symptoms
  • Past pain, imaging, treatment, consultations, procedures, etc (get old records)
  • Chronic medical problems
  • Medications: All including over-the-counter; verify via a prescription drug monitoring program (PDMP)—eg, the California Controlled Substance Utilization Review and Evaluation System (CURES)—or via urine drug screening
  • Alcohol and drugs: Current and past
  • Mental health
  • Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP), or similar

Physical examination

  • Vital signs
  • General examination
  • Specific detailed examination: Area of symptoms

Additional diagnostic evaluation as indicated

  • Imaging: Consider on the basis of pain level, injury, chronicity
  • Laboratory tests (including urine drug testing, renal and liver function)
  • Additional testing as needed

Assessment: As specific as possible

Treatment plan with goals (must be medically justified): Individualized

Informed consent about risks and benefits

Controlled substance agreement (optional but a good idea)

Medical records documentation: Be thorough

Consultation: When there is failure to improve or deterioration

Periodic review (follow-up visits)

  • Analgesia: Pain control
  • Activities of daily living
  • Adverse effects
  • Affect
  • Aberrant behaviors

Monitoring

  • CURES or other PDMP
  • Urine drug screening
  • Laboratory testing: As indicated; patient specific
  • Updated brief history, examination, assessment
  • Morphine equivalent dosing (MED) calculation and monitoring

Prescribing to addicts

  • Specific state and federal laws and statutes
  • “Trust but verify”: Be on the lookout for red flags of abuse, misuse, or diversion; addicts will say anything to get the drugs desired
  • Drug combinations: Common among those abusing or diverting: Opioids plus benzodiazepines with or without carisoprodol

Excessive or high-dose opioids: 100 mg/d MED, also referred to as morphine milliequivalents