For Prescribers

How to Discuss Starting Opioid Therapy

  1. Come to agreement with patient on what problem is being treated:  XYZ Pain
  2.  Identify the patient treatment goals using specific and measurable descriptors, ideally in the patient’s own words.  This may take some probing or co-creation of the goals to nail down some specifics. But, the patient has to endorse this goal.
    Examples of patient treatment goals:
    Using this medication…
    ...will help me get out of the house with my wife twice per week.
    ...will allow me to watch my grandchildren every weekend.
    ...will enable me to plant and maintain a vegetable garden this summer.
    ...will allow me to return to work full time.
    ...will help me to decrease days off from work (compared to last year when I took 23 sick days…)
    ...will help me get comfortable enough to lie down in bed.
  3. Present the opioids (or any other treatment for pain) as a test.  If they don’t help achieve the specified goals they will be stopped so that other treatments will be tried.  (Note: the entire goal may not be achieved, but the specific treatment should move the patient toward the goals).
  4. Review the risks of treatment (Sedation, addiction, constipation- also see risks and benefits of opioid treatment)
  5. Have patient sign informed consent about risks as part of controlled substance agreement
  6.  Review monitoring practices (urine drug screen, prescription refill policy)
  7. Set up next visit in 4-6 weeks to assess effect of pain medication.



Also see:

Provides clinicians serving adult populations in general medical settings with the tools and procedures necessary to conduct screening, brief intervention, and/or treatment referral for patients who may have or be at risk of developing a substance use disorder.

Publication Cover