Unsanctioned Dose Increases

These algorithms suggest actions to implement when a patient uses more opioids than prescribed or asks for an increased dose.  The algorithms come from a Delphi study in which a panel of experts developed consensus over four rounds of structured discussion. 

The algorithms include Recommended actions, which had full consensus of the experts as items to implement, and Not Recommended actions, which had the full consensus of actions NOT to do.  The Consider items could be implemented, depending on the specifics of the situation.  

Both of these algorithms are clear that stopping opioids therapy is NOT the first action when addressing these issues. 
Using more opioids than prescribed
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Asking for an increase in opioid dose
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Merlin JS, Young SR, Starrels JL, Azari S, Edelman EJ, Pomeranz J, Roy P, Saini S, Becker WC, Liebschutz JM. Managing Concerning Behaviors in Patients Prescribed Opioids for Chronic Pain: a Delphi study. J Gen Int Med, 2018 Feb:33(2):166-176.