Examples of Common Clinic Policies to Support Management of Chronic Opioid Therapy
| New patients currently on COT |
| All new patients require a urine drug test and copies of prior medical records prior to an opioid prescription |
| Standard elements of a pain assessment on all new patients |
| Established Patients COT Management |
| No refills on Monday and Fridays |
| No early refills for lost or stolen prescriptions or or a police report for such a refill |
| Face-to-face visit intervals required for a refill based on level of risk |
| 28-day supply only (to avoid running out on weekends) |
| Advanced notification period (e.g. 4 business days) for a refill request to be processed |
| Random urine drug screening frequency |
| Frequency of required PDMP check and who is responsible |
| Frequency and documentation of screening for depression and post traumatic stress disorder |
| Monitoring for co-prescribing of sedatives |
| Others: |
| No initiation of opioids to treat headaches, fibromyalgia or chronic low back pain |
| Standards for when a referral is required to a pain specialist or mental/behavioral health specialist (e.g., aberrant behaviors, high dose such as >100 morphine medication equivalent) |
COT, chronic opioid therapy; PDMP, prescription drug monitoring program.