Table 1.

Final Strategy Description List of 28 Strategies Organized by Category, Trial 3 (2018 to 2019)

Maintain Regulatory Compliance
1. Consider nonopioid alternatives, where possible
2. Provide patient education on benefits and risks, initiate treatment agreement, and obtain informed consent^*
3. Conduct ongoing risk assessment, such as the Current Opioid Misuse Measure (COMM), and update plan regularly^*
4. Assess patient function
5. Assess patient pain
6. Check Prescription Drug Monitoring Program^*
7. Screen urine at least annually for presence/absence of substances (may screen randomly, depending on risk)^*
8. Use best practices in prescribing: prescribe immediate release opioids, monitor closely any doses of greater than 50 or 90 MME/day, or concurrent dosing of benzodiazepines, and provide naloxone
9. Track dosage in MMEs, not only quantity prescribed
10. Short interval follow up after initiating new opioid treatment to review effect
11. Ongoing visits at least every 3 months^*
Improve Workflow/Streamline Care
12. Prescribe in multiples of 7 days in duration of dosage (eg, for 28 day, 56 days, … up to 84 days) to support consistent provider/patient relationships^*
13. Prewrite prescriptions for up to 84 days when management is stable^*
14. Use a flowsheet to document repeating strategies for opioid management^*
15. Roster: Include patient in registry for population management reports^*
Provide Peer-to-Peer Support
16. Use a team-based care approach to opioid treatment^*
17. Use strategies from the toolkit consistently, so that all patients receive care consistently across the clinic^*
18. Convene clinic members in a “Pain Management Council” regularly to review and discuss complex patient needs^*
19. Share skills that are widely useful; eg, how to have “trigger” conversations
20. Build community support with other partners/agencies
Monitor and Respond to Patients who may be at Risk
21. Conduct an initial Risk Assessment^*
22. Assess side effects (bowel habit, nausea, vomiting…)
23. Recognize special issues presented by patients for therapeutic conversations
24. Prescribe bubble packs if risk level increasing, depending on availability^†
25. Conduct pill counts or random pill counts^*
26. Create a tapering schedule with visits based on individual need
27. Identify resources that may be helpful and update periodically
28. Build a patient resource list or offer a library with books, CDs, etc.

MME, morphine milligram equivalents.
↵* Appeared in 1^st edition of the toolkit.
↵† Appeared in 2^nd edition of the toolkit.