Hieu-Pham/cpgQA huggingface dataset:
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Younger patients are at a higher risk of what?
Answer: opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior)
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Who were significantly less likely to have an aberrant UDT in comparison to patients in the 20-44 age  group?
Answer: patients in the 45-64 year age group
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: In comparison to patients in the 20-44 age  group, patients in the 45-64 year age group were significantly less likely to have what?
Answer: an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC])
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Patients in the 45-64 year age group were significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to whom?
Answer: patients in the 20-44 age  group
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Who were significantly less likely than 20-44 year olds to have non-detection of a prescribed opioid (indicating possible diversion)?
Answer: Patients in the 45-64 and ≥65 age groups
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: Patients in the 45-64 and ≥65 age groups were significantly less likely than whom to  have non-detection of a prescribed opioid (indicating possible diversion)?
Answer: 20-44 year olds
Recommendations

Younger patients are also at a higher risk of opioid misuse (as suggested by a UDT indicating high-risk  medication-related behavior). Turner et al. (2014) showed that patients in the 45-64 year age group were  significantly less likely to have an aberrant UDT (detection of a non-prescribed opioid, non-prescribed  benzodiazepine, illicit drug, or tetrahydrocannabinol [THC]) in comparison to patients in the 20-44 age  group.[94] Patients in the 45-64 and ≥65 age groups were significantly less likely than 20-44 year olds to  have non-detection of a prescribed opioid as well (indicating possible diversion).[94]  

Question: What are significantly less likely in patients in the 45-64 and ≥65 age groups than 20-44 year olds?
Answer: to  have non-detection of a prescribed opioid as well (indicating possible diversion)
Recommendations

An age of 30 years was chosen based on how age was categorized in the six studies that showed an inverse  relationship between age and OUD or overdose. One of those six studies found that patients with OUD  were younger than patients without OUD, but did not find a statistically significant relationship.[87] Two of  those six studies examined age as a continuous predictor, and neither reported a specific age where the  risk of OUD or overdose changed markedly.[62,92] One study examined age as a dichotomous (<65 and  ≥65) predictor.[88] In the two remaining studies, the highest risk included ages ranging from 18 to 30  years.[59,86] As such, the Work Group chose 30 years of age as a clinically reasonable threshold.  

Question: How was an age of 30 years chosen as a clinically reasonable threshold?
Answer: An age of 30 years was chosen based on how age was categorized in the six studies that showed an inverse  relationship between age and OUD or overdose.
Recommendations

Some may interpret the recommendation to limit opioid use by age as arbitrary and potentially  discriminatory when taken out of context; however, there is good neurophysiologic rationale explaining  the relationship between age and OUD and overdose. Studies in other areas (e.g., use of different  substances) indicate that developing brains (age <30 years) are at increased risk of abnormalities and  addiction when exposed to substance use early in life.[95-98]  

Question: What kind of rationale is there to explain the the relationship between age and OUD and overdose?
Answer: good neurophysiologic rationale
Recommendations

Some may interpret the recommendation to limit opioid use by age as arbitrary and potentially  discriminatory when taken out of context; however, there is good neurophysiologic rationale explaining  the relationship between age and OUD and overdose. Studies in other areas (e.g., use of different  substances) indicate that developing brains (age <30 years) are at increased risk of abnormalities and  addiction when exposed to substance use early in life.[95-98]  

Question: What indicate that developing brains (age <30 years) are at increased risk of abnormalities and  addiction when exposed to substance use early in life?
Answer: Studies in other areas (e.g., use of different  substances)
Recommendations

Some may interpret the recommendation to limit opioid use by age as arbitrary and potentially  discriminatory when taken out of context; however, there is good neurophysiologic rationale explaining  the relationship between age and OUD and overdose. Studies in other areas (e.g., use of different  substances) indicate that developing brains (age <30 years) are at increased risk of abnormalities and  addiction when exposed to substance use early in life.[95-98]  

Question: What are at increased risk of abnormalities and  addiction when exposed to substance use early in life?
Answer: developing brains (age <30 years)
Recommendations

Some may interpret the recommendation to limit opioid use by age as arbitrary and potentially  discriminatory when taken out of context; however, there is good neurophysiologic rationale explaining  the relationship between age and OUD and overdose. Studies in other areas (e.g., use of different  substances) indicate that developing brains (age <30 years) are at increased risk of abnormalities and  addiction when exposed to substance use early in life.[95-98]  

Question: What are the risks of substance use early in life?
Answer: increased risk of abnormalities and  addiction
Recommendations

Toward augmenting this evidence base, we recommend that future observational research examine age as  a continuous predictor of adverse outcomes. Additionally, we recommend that future trials examine which  risk mitigation strategies can reduce the additional risk of OUD and overdose in younger patients on LOT.  Lastly, a deeper understanding of the mechanisms for addiction to opioids in young brains is needed.

Question: What can be a continuous predictor of adverse outcomes?
Answer: age
Recommendations

We recommend implementing risk mitigation strategies upon initiation of long-term opioid  therapy, starting with an informed consent conversation covering the risks and benefits of opioid  therapy as well as alternative therapies. The strategies and their frequency should be  commensurate with risk factors and include: Ongoing, random urine drug testing (including appropriate confirmatory testing), Checking state prescription drug monitoring programs, Monitoring for overdose potential and suicidality, Providing overdose education, Prescribing of naloxone rescue and accompanying education  (Strong for | Reviewed, New-replaced) 

Question: What is recommended upon initiation of long-term opioid  therapy?
Answer: implementing risk mitigation strategies
Recommendations

We recommend implementing risk mitigation strategies upon initiation of long-term opioid  therapy, starting with an informed consent conversation covering the risks and benefits of opioid  therapy as well as alternative therapies. The strategies and their frequency should be  commensurate with risk factors and include: Ongoing, random urine drug testing (including appropriate confirmatory testing), Checking state prescription drug monitoring programs, Monitoring for overdose potential and suicidality, Providing overdose education, Prescribing of naloxone rescue and accompanying education  (Strong for | Reviewed, New-replaced) 

Question: How to implement risk mitigation strategies upon initiation of long-term opioid  therapy?
Answer: starting with an informed consent conversation covering the risks and benefits of opioid  therapy as well as alternative therapies
Recommendations

We recommend implementing risk mitigation strategies upon initiation of long-term opioid  therapy, starting with an informed consent conversation covering the risks and benefits of opioid  therapy as well as alternative therapies. The strategies and their frequency should be  commensurate with risk factors and include: Ongoing, random urine drug testing (including appropriate confirmatory testing), Checking state prescription drug monitoring programs, Monitoring for overdose potential and suicidality, Providing overdose education, Prescribing of naloxone rescue and accompanying education  (Strong for | Reviewed, New-replaced) 

Question: What should be commensurate with risk factors?
Answer: The strategies and their frequency
Recommendations

We recommend implementing risk mitigation strategies upon initiation of long-term opioid  therapy, starting with an informed consent conversation covering the risks and benefits of opioid  therapy as well as alternative therapies. The strategies and their frequency should be  commensurate with risk factors and include: Ongoing, random urine drug testing (including appropriate confirmatory testing), Checking state prescription drug monitoring programs, Monitoring for overdose potential and suicidality, Providing overdose education, Prescribing of naloxone rescue and accompanying education  (Strong for | Reviewed, New-replaced) 

Question: What should be included in the risk mitigation strategies and their frequency?
Answer: Ongoing, random urine drug testing (including appropriate confirmatory testing), Checking state prescription drug monitoring programs, Monitoring for overdose potential and suicidality, Providing overdose education, Prescribing of naloxone rescue and accompanying education
Recommendations

Risk mitigation for LOT should begin before the opioids are prescribed, through an informed consent  discussion, reviewing the patient’s history, checking state PDMPs, or instructing patients about using drug  take back programs to dispose of unused medication. It should also occur concurrently with the therapy  (e.g., ongoing UDT, OEND) and in response to adverse events (e.g., needle exchange programs for those  who develop an intravenous drug use disorder). The 2010 OT CPG recommended use of an opioid pain  care agreement, monitoring for appropriate opioid use, and, with patients’ consent, obtaining a UDT. A  literature search was conducted dating back to the original 2010 recommendation to identify studies  comparing the effectiveness of different risk mitigation strategies for patients on or being considered for  LOT. One identified study was a systematic review of 11 studies looking at opioid treatment agreements  (OTAs) and UDT strategies utilizing opioid misuse risk reduction as the main outcome measure.[99] The  study revealed weak evidence to support the use of OTAs and UDT. A second study, a retrospective  database study, demonstrated decreased risk of suicide attempts in various cohorts with frequent UDT,  regular follow-up (including follow-up within four weeks for patients with new opioid prescription), and  rehabilitative services are offered.[61] The confidence in the quality of the evidence was moderate for the  outcome of attempted suicide risk. The third study was a retrospective cohort study that looked at the  intervention of a clinical pharmacist guidance team versus control.[100] Outcome measures included  adverse events, pain management, and quality of life. Details of the actual intervention were vague and  did not necessarily include OTAs or UDT. Thus, the confidence in the quality of the evidence was very low.  The confidence in the quality of the evidence was moderate for UDT and frequent follow-up and was low  for OTAs. The frequency of follow-up and monitoring should be based on patient level of risk as  determined by an individual risk assessment.  

Question: When should risk mitigation for LOT begin?
Answer: before the opioids are prescribed
Recommendations

Risk mitigation for LOT should begin before the opioids are prescribed, through an informed consent  discussion, reviewing the patient’s history, checking state PDMPs, or instructing patients about using drug  take back programs to dispose of unused medication. It should also occur concurrently with the therapy  (e.g., ongoing UDT, OEND) and in response to adverse events (e.g., needle exchange programs for those  who develop an intravenous drug use disorder). The 2010 OT CPG recommended use of an opioid pain  care agreement, monitoring for appropriate opioid use, and, with patients’ consent, obtaining a UDT. A  literature search was conducted dating back to the original 2010 recommendation to identify studies  comparing the effectiveness of different risk mitigation strategies for patients on or being considered for  LOT. One identified study was a systematic review of 11 studies looking at opioid treatment agreements  (OTAs) and UDT strategies utilizing opioid misuse risk reduction as the main outcome measure.[99] The  study revealed weak evidence to support the use of OTAs and UDT. A second study, a retrospective  database study, demonstrated decreased risk of suicide attempts in various cohorts with frequent UDT,  regular follow-up (including follow-up within four weeks for patients with new opioid prescription), and  rehabilitative services are offered.[61] The confidence in the quality of the evidence was moderate for the  outcome of attempted suicide risk. The third study was a retrospective cohort study that looked at the  intervention of a clinical pharmacist guidance team versus control.[100] Outcome measures included  adverse events, pain management, and quality of life. Details of the actual intervention were vague and  did not necessarily include OTAs or UDT. Thus, the confidence in the quality of the evidence was very low.  The confidence in the quality of the evidence was moderate for UDT and frequent follow-up and was low  for OTAs. The frequency of follow-up and monitoring should be based on patient level of risk as  determined by an individual risk assessment.  

Question: What should be done before the opioids are prescribed?
Answer: Risk mitigation for LOT should begin
Recommendations

Risk mitigation for LOT should begin before the opioids are prescribed, through an informed consent  discussion, reviewing the patient’s history, checking state PDMPs, or instructing patients about using drug  take back programs to dispose of unused medication. It should also occur concurrently with the therapy  (e.g., ongoing UDT, OEND) and in response to adverse events (e.g., needle exchange programs for those  who develop an intravenous drug use disorder). The 2010 OT CPG recommended use of an opioid pain  care agreement, monitoring for appropriate opioid use, and, with patients’ consent, obtaining a UDT. A  literature search was conducted dating back to the original 2010 recommendation to identify studies  comparing the effectiveness of different risk mitigation strategies for patients on or being considered for  LOT. One identified study was a systematic review of 11 studies looking at opioid treatment agreements  (OTAs) and UDT strategies utilizing opioid misuse risk reduction as the main outcome measure.[99] The  study revealed weak evidence to support the use of OTAs and UDT. A second study, a retrospective  database study, demonstrated decreased risk of suicide attempts in various cohorts with frequent UDT,  regular follow-up (including follow-up within four weeks for patients with new opioid prescription), and  rehabilitative services are offered.[61] The confidence in the quality of the evidence was moderate for the  outcome of attempted suicide risk. The third study was a retrospective cohort study that looked at the  intervention of a clinical pharmacist guidance team versus control.[100] Outcome measures included  adverse events, pain management, and quality of life. Details of the actual intervention were vague and  did not necessarily include OTAs or UDT. Thus, the confidence in the quality of the evidence was very low.  The confidence in the quality of the evidence was moderate for UDT and frequent follow-up and was low  for OTAs. The frequency of follow-up and monitoring should be based on patient level of risk as  determined by an individual risk assessment.  

Question: How should risk mitigation for LOT begin before the opioids are prescribed?
Answer: through an informed consent  discussion, reviewing the patient’s history, checking state PDMPs, or instructing patients about using drug  take back programs to dispose of unused medication
Recommendations

Risk mitigation for LOT should begin before the opioids are prescribed, through an informed consent  discussion, reviewing the patient’s history, checking state PDMPs, or instructing patients about using drug  take back programs to dispose of unused medication. It should also occur concurrently with the therapy  (e.g., ongoing UDT, OEND) and in response to adverse events (e.g., needle exchange programs for those  who develop an intravenous drug use disorder). The 2010 OT CPG recommended use of an opioid pain  care agreement, monitoring for appropriate opioid use, and, with patients’ consent, obtaining a UDT. A  literature search was conducted dating back to the original 2010 recommendation to identify studies  comparing the effectiveness of different risk mitigation strategies for patients on or being considered for  LOT. One identified study was a systematic review of 11 studies looking at opioid treatment agreements  (OTAs) and UDT strategies utilizing opioid misuse risk reduction as the main outcome measure.[99] The  study revealed weak evidence to support the use of OTAs and UDT. A second study, a retrospective  database study, demonstrated decreased risk of suicide attempts in various cohorts with frequent UDT,  regular follow-up (including follow-up within four weeks for patients with new opioid prescription), and  rehabilitative services are offered.[61] The confidence in the quality of the evidence was moderate for the  outcome of attempted suicide risk. The third study was a retrospective cohort study that looked at the  intervention of a clinical pharmacist guidance team versus control.[100] Outcome measures included  adverse events, pain management, and quality of life. Details of the actual intervention were vague and  did not necessarily include OTAs or UDT. Thus, the confidence in the quality of the evidence was very low.  The confidence in the quality of the evidence was moderate for UDT and frequent follow-up and was low  for OTAs. The frequency of follow-up and monitoring should be based on patient level of risk as  determined by an individual risk assessment.  

Question: When should risk mitigation for LOT occur?
Answer: concurrently with the therapy  (e.g., ongoing UDT, OEND) and in response to adverse events (e.g., needle exchange programs for those  who develop an intravenous drug use disorder)