Table 3.

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
    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.