Screening Instruments

  • Opioid Risk Assessment and Scoring
  • Emerging Solutions – Provides 9 risk assessments in PDFs that can be downloaded and printed. (Look under Tools tab.) Includes:
    • ORT
    • DIRE (Brief provider report for assessing potential for medication misuse)
    • SOAPP-R (Self-report scale for patients being considered for chronic opioid therapy)
  • COMM from
    17 Items validated on 500 chronic opioid patients on chronic opioid therapy. Used with patients already on opioids to monitor for medication misuse, although this is not a lie detector test so can be feigned.

Checklist for Pre-Opioid Screening

  1. Previous work up reviewed or new studies ordered
  2. Determine previous providers reasons for prescribing/not prescribing
  3. Past treatments and responses/side effects
  4. Current treatments and responses/side effects
  5. Current self-management of pain
  6. Healthy behaviors
  7. Unhealthy behaviors
  8. Past mental health problems/treatments
  9. Current mental health status (especially mood, anxiety)
  10. Past medication misuse and substance abuse
  11. Age of onset of substance abuse
  12. Current medication misuse and substance abuse
  13. Smoking status
  14. Family history of substance abuse (Number of primary relatives, Number of secondary relatives)
  15. Urine drug screen congruent with prescribed medications and absence of illicit drugs
  16. Reviewed WV Board of Pharmacy website for polypharmacy and polyprescribers
  17. History of any abuse or neglect during childhood or physical abuse as adult
  18. History of legal problems
  19. Co morbid medical issues (COPD, Liver disease, etc)
  20. History of adherence to other medical treatments

Risk Level and Recommended Protocols

New Patients with Existing Chronic Pain

Patients presenting to establish care at a health care facility with pre-existing constant or recurring pain of 3 or more months’ duration will complete a screening process before being prescribed a controlled substance.

New patients to clinic: No opioids written first visit

Before opioids are prescribed:

  • Previous records must be received (from previous provider). Staff to call former providers to review previous treatment and confirm reason for transfer of care.
  • Urine or serum drug screen required
    • Illicit drugs present
    • Appropriate presence of prescribed medications if patient states taking them
  • Physical exam completed and documented
  • Review of diagnostic studies which confirms diagnosis indicating opioid therapy
  • WV Board of Pharmacy review
  • Psychosocial screening completed and risk status noted
  • Controlled substance agreement/ consent form signed
  • Treatment plan includes non-opioid options
  • Document plan in chart
  • Document when review of status needed (frequency based on risk status)
  • May require separate patient visit to address only pain initially and annually
  • All controlled substances scripts printed electronically
  • All non-physicians must inform supervisors of new or renewal of controlled substance prescriptions

Protocol for Established Patients with New-Onset of Pain

  • Chart review to obtain background information
  • Refer patient to resources for self-management
  • Set positive expectations for symptom improvement
  • Set expectation for self-management
  • Screening for opioid risk and set expectation for limited pain medication (if offered)
  • No opioids after 6 weeks unless extreme circumstances
  • If continued after 6 weeks, enact protocol for new patients with chronic pain

Protocol for Monitoring Patients on Chronic Opioid Therapy

Universal precautions for all patients

  1. Low risk
    1. Annual UDS
    2. Annual BOP review
    3. Other treatments and/or self-management practices documented
    4. Annual re-screening for opioid risk status
  2. Moderate risk
    1. Every 4-6 months UDS
    2. Every 4-6 months Board of Pharmacy review
    3. Other treatments and/or self-management documented
    4. Every 6 months re-screening for opioid risk status
    5. Behavioral staff part of ongoing care
  3. High Risk
    1. Interval prescribing of less quantity(q week or q day?)
    2. UDS monthly or less
    3. WV CSAPP: check prior to each script
    4. Require concurrent addiction specialist intervention