CDC Recommendations
CDC Recommendation 9: Using PDMP/CSD to monitor
When prescribing initial opioid therapy for acute, sub-acute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.
Utah Supplemental Recommendations
OBTAIN URINE DRUG SCREENS
Prescribers should perform drug screening on randomly selected visits and any time aberrant behavior is suspected.
A good practice is to give all patients taking chronic controlled substance prescriptions at least an annual urine test and high-risk patients more frequent random urine tests with no advance notice. Drug testing has been shown to identify the presence of illegal drugs, unreported prescribed medication, unreported alcohol use, and the absence of the patient’s prescribed medication. This assists the prescriber in determining whether the opioid therapy is appropriate and in determining the required frequency of monitoring. It also provides an opportunity to discuss the risks of opioid treatment. Random pill counts may also be useful.
Immunoassays can be done in the office. These screening tests determine if opioids are present but do not identify specific ones, which can subsequently be determined by confirmatory laboratory testing. However, in many cases, confirmation testing can be eliminated by carefully going over the results of the initial in-office test with the patient. Prescribers need to recognize that immunoassays have both false positive and false negative results. Over-the-counter medication, for example, can cause a positive result. Many synthetic opioids are not detected by urine immunoassay screening and require confirmation testing if suspected. The prescriber may want to consider confirmatory testing or consultation with a certified medical review officer if drug test results are unclear.
An abnormal drug screen should be specified in the treatment plan as a possible reason to cease treatment.
PREVENT PRESCRIPTION FRAUD
The prescription for opioid therapy should be written on tamper-resistant prescription paper or e-prescribed to prevent prescription fraud.
To reduce the chance of tampering with the prescription, write legibly and keep a copy in your records. According to the Drug Enforcement Administration (DEA), all records related to controlled substances must be maintained and be available for inspection for a minimum of two years.
