See below for more details
Monitoring Tools:
Urine drug testing (See “About Urine Drug Testing,” “Interpreting Urine Drug Tests”)
- Every 6 months for low risk patients.
- More often for higher risk patients.
- Every visit for very high risk patients.
State prescription monitoring program (PMP) (See “Using the PMP Effectively“)
- At start of new prescription.
- When prescribing to new patient, even if evidence of prior use.
- At least yearly, more often if there is high risk.
Pill counts (See “Pill Counts“)
- If there is suspicion of misuse, conduct 1 week before new prescription due.
- Some at every visit.
Recommended Risk Monitoring Schedule
Risk Level | Urine Drug Tests (per Year) | Prescription Drug Monitoring Plan (per Year) | Pill Counts (per Year) | Minimum Primary Care Physician Visits (per Year)* |
|---|---|---|---|---|
| Low risk in first 12 months of treatment | 1-3 | 1-3 | 1 | 4 |
| Low | 1-2 | 1 | 0 | 4 |
| Moderate | 3-4 | 3 | 1-2 | 4 |
| High | Min 6 - up to every prescription | 4 | 3+ | 6 |
| UDT frequency may be dictated by regulations for more frequent intervals | PDMP frequency may be dictated by regulations for more frequent intervals | *DEA regulations on controlled substance are for 1 month supply and 2 additional refills before face to face visit | ||
| *Note that monitoring should be more intensive during the first 6 months of opioid therapy | ||||
Also see: “Determination of Risk”
Sources:
Christo PJ et al. Urine drug testing in chronic pain. Pain Physician 2011:14:123-143.
Heit HA and Gourlay DL. Urine drug testing in pain medicine. J Pain Symptom Manage 2004;27:260-267.
Katz NP et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg 2003.
Manchikanti L et al. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Physician 2006.
Nicolaidis C. Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management. Pain Med 2011;12(6):890-897.
Peppin JF et al. Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain. Pain Medicine 2012;13:886-896.
Perrone J, Nelson LS. Medication reconciliation for controlled substances–an “ideal” prescription-drug monitoring program. N Engl J Med 2012; 366:25:2341-2343.
Pesce A et al. Illicit drug use in the pain patient population decreases with continued drug testing. Pain Physician 2011.