Table 5.

Ongoing monitoring to support chronic opioid therapy in primary care.

New patient acceptance criteria  Absolute contraindications   Severe respiratory instability   Acute psychiatric instability or uncontrolled suicide risk   True allergy to opioid agents (cannot be resolved by switching agents)   Serious adverse effects that cannot be treated   Illicit drug conviction  Relative contraindications   Medical condition in which COT may cause harm (eg, COPD)   Complicated pain (eg, headache not responsive to other pain treatment modalities)   Psychosocial behavioral overlay conditions Prior to initiation of COT  Review of prior medical records  Establishment diagnosis that justifies COT  Review patients PAT for inconsistencies  Urinary drug screen  Screen and assess the patient’s risk (SOAPP-R, ORT)  Signed pain management agreement  Only use 1 pharmacy  Only 1 provider Established patient currently on COT  Signed pain management agreement  Random urinary drug screen  Review patients PAT for inconsistencies  No early refills  Police report for all lost prescriptions  30-D supply only  Monitor for co-prescribing of sedatives Others  Naloxone prescribed to all patients >50 mg MEDD  Established protocol of referral to interventionalist or mental health specialist (eg, aberrant behavior, >90 mg MEDD)  Primary goal of treatment should be clinically significant improvement in function

Abbreviations: COPD, chronic obstructive pulmonary disease; COT, chronic opioid therapy; MEDD, morphine equivalent daily dose; ORT, opioid risk tool; PAT, prescription access in Texas database; SOAPP-R, screener and opioid assessment for patients with pain-revised.