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.
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 assessments should include open-ended questions to assess the patient's work activities, leisure activities and activities of daily living. The Colorado Division of Workers' Compensation Quality Performance Outcomes Payments (QPOP) Program Functional Tools are useful.
Colorado Physician Drug Monitoring Program (PDMP)
Any patient with the continued use of opioids should be monitored.
Drug Testing is required when a patient starts a trial of opioids. The following Interagency Guideline on Prescribing Opioids for Pain, developed by the Washington State Agency Medical Directors' Group (AMDG) is useful information regarding drug testing:
- 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)
- Motivational Interviewing in Health Care
- American Association of Chronic Pain Opioid information
- Substance Abuse and Mental Health Services Administration: Opioid Prescribing Courses for Health Care Providers
- Medical Society of the State of New York: Pain Management, Palliative Care and Addiction 3 hour Webinar
- Opioid Risk Tool
- CAGE Substance Abuse Screening Tool