Opioid Management and Monitoring

Initial Assessment and Ongoing Reassessment

• The Centers for Disease Control and Prevention recommends that clinicians systematically assess treatment efficacy, medication adherence, adverse effects, signs of opioid use disorder, and whether benefits continue to outweigh risks at every MAR follow-up visit, with initial follow-up within 1-4 weeks and ongoing reassessment at least every 3 months 1, 2
• Assess pain control by asking about average pain levels and whether pain relief is sustained throughout the dosing interval, as recommended by the Centers for Disease Control and Prevention 1, 3
• Evaluate functional improvement by assessing interference with enjoyment of life and general activity using structured tools like the PEG scale, as suggested by the Centers for Disease Control and Prevention 1, 2
• Determine progress toward functional goals by asking specifically about meaningful activities the patient wanted to resume, such as work, family responsibilities, or social engagement, as recommended by the Centers for Disease Control and Prevention 1, 3
• Assess quality of life changes by determining if overall well-being has improved since starting treatment, as suggested by the Centers for Disease Control and Prevention 1, 4
• Identify patients without pain relief at 1 month, as they are unlikely to experience benefit at 6 months, making this an essential decision point for continuing therapy, according to the Centers for Disease Control and Prevention 5, 3
• Ask about self-administration patterns, such as taking the medication exactly as prescribed or feeling the need to take more or take it more frequently, as recommended by the Centers for Disease Control and Prevention 1, 2
• Screen for common side effects, including constipation, drowsiness or sedation, nausea or vomiting, and dry mouth, as suggested by the Centers for Disease Control and Prevention 1, 2, 7
• Identify warning signs of serious complications, such as sedation or slurred speech, confusion or cognitive impairment, respiratory symptoms, and syncope or seizures, as recommended by the Centers for Disease Control and Prevention 1, 2, 8
• Ask directly about craving, loss of control, escalating use, and functional impairment to assess opioid use disorder, as suggested by the Centers for Disease Control and Prevention 1, 8, 2
• For patients on methadone, assess dose adequacy for pain and ask about cardiac symptoms, as recommended by the Clinical Infectious Diseases journal 6
• Evaluate sustained benefit, patient preference, and dose optimization at every 3-month follow-up, as suggested by the Centers for Disease Control and Prevention 1, 8, 2
• Identify high-risk patients who require more frequent follow-up, including those with depression, history of substance use disorder, history of overdose, dosage ≥50 MME/day, or concurrent benzodiazepines or other CNS depressants, as recommended by the Centers for Disease Control and Prevention 8, 2, 7
• Assess substance use, including illicit opioid use, other substance use, and injection drug use, as suggested by the Clinical Infectious Diseases journal 9
• Evaluate the support system, including family awareness, medication reminders, recovery support, and logistical barriers, as recommended by the Clinical Infectious Diseases journal 9
• Discontinue or reduce dose if the patient experiences overdose or serious adverse events, has no sustained improvement in pain and function, or is on a high-risk regimen without clear benefit, as suggested by the Centers for Disease Control and Prevention 2, 7, 8
• Consider more intensive monitoring if starting or increasing ER/LA opioids, starting or increasing methadone, or if the total daily dose is ≥50 MME/day, as recommended by the Centers for Disease Control and Prevention 5, 1, 7
• Obtain signed release to exchange information between prescribers before prescribing any controlled substances for patients in opioid treatment programs, as suggested by the Clinical Infectious Diseases journal 6