DORA Guidelines for the Safe Prescribing and Dispensing of Opioids
Opioid Management Report
Translating Morphine Equivalents
Morphine Equivalents above 50/day carries an increased risk of overdose and the provider may consider other measures of treatment and/or taper if above 90 meq per day.
Review the Morphine Equivalent Dose (MED) Calendar
Tools for Risk Assessment and Mental Health Screening
For patients with chronic opioid usage, a psychological evaluation must be performed (per the Medical Treatment Guidelines).
For patients with acute opioid usage, psychological screens may be used from the Colorado Division of Workers' Compensation Quality Performance Outcomes Payments (QPOP) Program.
Functional Assessment
Functional assessments should include open-ended questions to assess the patient's work activities, leisure activities and activities of daily living. Use the Quality Performance Outcomes Payments (QPOP) Program Functional Tools provided by the Colorado Division of Workers' Compensation are useful.
Colorado Physician Drug Monitoring Program (PDMP)
Any patient with the continued use of opioids should be monitored. Learn about monitoring and the Prescription Drug Monitoring Program.
Drug Testing
Drug Testing is required when a patient starts a trial of opioids. The Interagency Guideline on Prescribing Opioids for Pain offers useful information regarding drug testing, and was developed by the Washington State Agency Medical Directors' Group (AMDG):
- Using Urine Drug Testing (UDT) to Monitor Opioid Therapy for Chronic Non-cancer Pain (p. 63)
- UDT Algorithm for Monitoring Opioid Therapy (p. 67)
- UDT Clinical Vignettes in Chronic Non-cancer Pain (p. 68)
- UDT Frequently Asked Questions (FAQ) (p. 70)