__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use tial benefits and risks to the patient. The elements
treatment of these conditions [116]. Periodic reas- sessment is necessary because patient circumstances and the benefit/risk balance of opioid therapy can change, due to alterations in the primary pain con- dition, comorbid disease, or psychological or social circumstances [115]. Before Opioid Therapy Initiation Screening and assessment tools can help guide patient stratification according to risk level and inform the appropriate degree of structure and monitoring in the treatment plan. It should be noted that despite widespread endorsement of screening tool use to help determine patient risk level, most screening tools have not been extensively evaluated, validated, or compared to each other, and evidence of their reliability is poor [97]. In addition to screening and assessment tools, urine drug testing, monitoring of prescribing practices, prescription monitoring programs, opioid treatment agreements, and utilization of universal precautions are essential. Presently, a combination of strategies is recommended to stratify risk, to identify and understand aberrant drug-related behaviors, and to tailor treatments accordingly [117].
of such an assessment include [113]: • Pain indications for opioid therapy • Nature and intensity of pain • Past and current pain treatments and patient response • Comorbid conditions • Pain impact on physical and psychological function • Social support, housing, and employment • Home environment (i.e., stressful or supportive) • Pain impact on sleep, mood, work, relationships, leisure, and substance use • Patient history of physical, emotional, or sexual abuse If there is a history of substance abuse, active or in remission, consult an addiction specialist before starting opioids [113]. In active substance abuse, do not prescribe opioids until the patient is engaged in a treatment/recovery program or other arrangement made, such as addiction professional co-management and additional monitoring. When considering an opioid analgesic (particularly ER or LA types), one must always weigh the benefits against the risks of overdose, abuse, addiction, physical dependence and tolerance, adverse drug interactions, and accidental ingestion by children [114]. RISK ASSESSMENT TOOLS Risk assessment involves a determination of whether potential opioid benefits outweigh the potential risks. The individual and public health conse- quences of prescription opioid abuse, addiction, diversion, and overdose justify assessment and risk stratification in every patient considered for long- term opioid therapy [115]. Patients with chronic pain and past or current alcohol or drug abuse, psychiatric illness, or serious aberrant drug-related behaviors should still be considered for opioid therapy, but with tighter monitoring conditions and consultation from mental health or addiction specialists. Pain management outcomes are nega- tively affected by untreated psychiatric comorbidity, and proper assessment can identify and lead to the
The American Society of Interventional Pain Physicians recommends screening for opioid abuse, as it will potentially identify opioid abusers and reduce opioid abuse. (https://painphysicianjournal.com/current/ pdf?article=NDIwMg%3D%3D&journal=10
3. Last accessed August 15, 2023.) Level of Evidence : II (Evidence obtained from at least one relevant, high-quality randomized controlled trial or multiple relevant moderate- or low-quality randomized controlled trials) Opioid Risk Tool The Opioid Risk Tool (ORT) is a five-item assess- ment to help predict aberrant drug-related behavior. It is also used to establish patient risk level through patient categorization into low, medium, or high levels of risk for aberrant drug-related behaviors based on responses to questions of previous alcohol/ drug abuse, psychological disorders, and other risk factors [27].
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MDMS1526
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