Features and overview

Opioids are associated with many risks and it may be determined that they are not indicated for pain management for a particular Veteran. Re-evaluate the risks and benefits of continuing opioid therapy when there is no pain reduction, no improvement in function or patient requests to discontinue therapy, severe unmanageable adverse effects, dosage indicates high risk of adverse events, concerns related to an increased risk of SUD (Substance use disorder) (e.g., behaviors, age < 30, family history, personal history of SUD), an overdose event involving opioids, non-adherence to the treatment plan or unsafe behaviors. Examples of severe unmanageable adverse effects are drowsiness, constipation, and cognitive impairment. Examples of dosage that indicate high risk of adverse events are doses of 90 MEDD (Morphine equivalent daily dose) and higher. Examples of unsafe behaviors are early refills, lost/stolen prescription, buying or borrowing opioids, failure to obtain or aberrant UDT.

Question: When to re-evaluate the risks and benefits of continuing opioid therapy?
Answer: no pain reduction, no improvement in function or patient requests to discontinue therapy, severe unmanageable adverse effects, dosage indicates high risk of adverse events, concerns related to an increased risk of SUD (Substance use disorder) (e.g., behaviors, age < 30, family history, personal history of SUD), an overdose event involving opioids, non-adherence to the treatment plan or unsafe behaviors

Question: What does it mean by severe unmanageable adverse effects?
Answer: drowsiness, constipation, and cognitive impairment

Question: How much dosage indicates high risk of adverse events?
Answer: doses of 90 MEDD (Morphine equivalent daily dose) and higher

Question: What to do when there is no pain reduction?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What to do when there is no improvement in function?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What to do when patient requests to discontinue therapy?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What to do when there are severe unmanageable adverse effects?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What are some examples of severe unmanageable adverse effects?
Answer: drowsiness, constipation, and cognitive impairment

Question: What to do when dosage indicates high risk of adverse events?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What dosage indicates high risk of adverse events?
Answer: doses of 90 MEDD (Morphine equivalent daily dose) and higher

Question: What to do when there is non-adherence to the treatment plan or unsafe behaviors?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What are examples of non-adherence to the treatment plan or unsafe behaviors?
Answer: early refills, lost/stolen prescription, buying or borrowing opioids, failure to obtain or aberrant UDT

Question: What to do when there are concerns related to an increased risk of SUD?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: What to do when there are concerns related to an increased risk of substance use disorder?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy

Question: Which factors can raise concerns related to an increased risk of substance use disorder?
Answer: behaviors, age < 30, family history, personal history of SUD

Question: Which behaviors can be characterized as unsafe?
Answer: early refills, lost/stolen prescription, buying or borrowing opioids, failure to obtain or aberrant UDT

Question: What to do when there is an overdose event involving opioids?
Answer: Re-evaluate the risks and benefits of continuing opioid therapy