Chronic Pain Update 2013: New Data and Perspectives - Episode 14

Comprehensive Opioid Risk Management

In this segment, panelist Joseph Pergolizzi, MD, describes effective methods and tools to monitor adherence to opioid therapy and detect aberrant un-prescribed drug use in pain patients.

According to Pergolizzi, biological, psychological, and social warning signs for patients who may be more susceptible to the non-medical use of chronic opioid therapy include “a personal or family history of alcohol or substance abuse (or) of mental disorders like major depressive syndrome,” though other red flags are related to how the patient presents, such as “want(ing) their office visits at 4 o’clock on Fridays, because that’s when maybe everyone wants to just get out of the office real quick.”

After stratifying pain patients into low and high risk groups based on those warning signs, Pergolizzi recommends screening patients for opioid use or misuse by using what he calls a “comprehensive compliance monitoring program” — one of which is urine drug testing. However, he notes that such testing “can cost as much, if not more than, an MRI.”

“It’s very difficult sometimes to do a procedure, get an MRI for that, and then six months later get an MRI just to see how things went, but with urine drug testing, it’s not uncommon to have even some state boards say, ‘We want you to drug test three times a year,’” Pergolizzi says. “So, I think we have to add it into the whole entire comprehensive monitoring program, which includes educating your patient (and) using other tools like the Clinical Opioid Withdrawal Scale.”