Cannabis: How many joints do you smoke per day or week? Cocaine: Have you used any cocaine in the past year? Over-the-counter drugs: Do you regularly use over-the-counter medications for sleep or nausea? Opioids: In the past year, have you used opioids from any source (eg, over the counter [Tylenol No. 1], prescriptions from other physicians, borrowed from friends or family, or buying from the street)? How much did you take and how often? Do you crush or inject oral tablets? Have you experienced opioid withdrawal symptoms (eg, myalgia, gastrointestinal symptoms, insomnia, or dysphoria)? Have you had a previous opioid problem? Have you ever attended a treatment program for opioid addiction (eg, methadone clinic)? Benzodiazepines: How much and how often do you take benzodiazepines and where do you get them from?

Reprinted from the National Opioid Use Guideline Group.³