Table 3.

Excerpts from patient visit transcripts.

Alternative treatments
	Provider: So, you do exercises? Patient: Yes. Provider: What kind of exercises? Patient: Squats. Leg lifts. Provider: Who instructed you on those things? Patient: When I went through physical therapy, you know how they give you little paper pamphlets to do exercise after the therapy is over that you can start doing them? So, I memorized them so well.
Pain severity
	Provider: And you’re still taking the patches, but – oh, so your pain is at a six, seven? Patient: Yeah. Provider: Would you say that’s less for you than before or about the same? Patient: I don’t know, I say that it’s about the same. I’ve been doing a lot more walking, but the pain is the same. Well, no, it’s been hurting a lot at night.
Progress toward treatment goals		Provider: Okay. All right. So, tell me in your own words, why I’m giving you – what the goal is for the medicine, the opiates I’m giving you? Like what do you think it should be doing? Patient: It should be taking away, you know, modifying the pain in my right knee, so my leg wouldn’t give out or get stiff.
Benefit of current opioid use	Provider: Okay. Now, do any of these medications that I’m giving you – the morphine and the Vicodin, do they control your pain adequately? Patient: Yes. They do. Provider: Okay. Do you need more? Patient: No. I don’t. No. I just got them the other day. And I need them, thank god, because they didn’t give me anything for the pain after the surgery.
Adherence to prescribed opioid	Provider: You’re doing the six pills a day, right, as much as supposed to? Patient: Yeah, mm-hmm.
Assessing risks and harms	Provider: So, you’re not using any other drugs? Patient: No. Provider: No recent overdose? No. Sedation and intoxication? No. Benefits of opioids? Yes, I think it seems to be helping you a little bit.
Opioid-related harms (opioid use disorder, overdose)	Provider: Okay. Notes on Ambien. I’m just gonna write down. Do you have any previous history of substance abuse? Patient: No. Provider: IV drug use? Patient: No. Provider: Nothing like that? Patient: No. Provider: Okay. Any family history of substance abuse– Patient: Older brother. … Provider: Do you ever lose control? Are you compulsive in what you do? Do you use a lot of your Vicodin or morphine –? Patient: No. I don’t hardly use it.
Monitoring: PDMP and urine drug test		Provider: All right. You’re going to do a urine test, also. Okay? Patient: I’ll try to. I went before I went home but if I drink some water, that will probably make me go. Provider: Just to make sure you have the medicine in you.
Assess morphine equivalency	Provider: And you are on Vicodin and morphine? Patient: Mm-hmm. Provider: Correct? Patient: Yeah. Provider: And the opioid medications are Vicodin and morphine. And you’re morphine equivalent – I have the app. So, your morphine is 30 q 8, so that’s 90 mg.
Opioid refill/increase/taper	Provider: I don’t know that I feel comfortable increasing your pain medication. I might have you see someone here to evaluate you to figure out whether you’re on the best pain regimen.
Risk mitigation		Provider: I wanna make sure … yeah, just – this [Naloxone prescription] is just for protection. To benefit you … I’m gonna give you four sprays. Okay? Patient: Mm-hmm. Provider: For each refill. It’s just to protect you. Repeat every – what’s it say? It says, “Repeat every two to three minutes.” Repeat every two to three minutes until patient is responsive. You live with someone at home? Or you’re just by yourself? Patient: Just by myself. Patient: Just by myself.