A. Review patient's medical history for risks of complications or dependence:
There are numerous screens available to assess risk of potential opioid misuses and abuse. Common risk factors included in most screening tools include:
• History of substance use disorder
• History of mental illness (especially if history includes psychotropic medications)
Consider using validated screening tools such as:
The mnemonic ABCD-PQRS provides a simple way to remember contraindications to opioids. See the image below for more details.
The COMM™ will help clinicians identify whether a patient, currently on long-term opioid therapy, may be exhibiting aberrant behaviors associated with misuse of opioid medications.
The Screener and Opioid Assessment for Patients with Pain-Revised predicts possible opioid abuse in chronic pain patients with a list of 24 scored questions inquiring about frequency of behavior. Patients will respond with Never (0), Seldom (1), Sometimes (2), Often (3), Very Often (4). The average of response scores will indicate level of risk for abuse. See the image on the right for questions.
The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems.
This questionnaire consists of very general questions that allows the clinician to screen for both drug and alcohol abuse conjointly rather than separately. An affirmative response to a question would have a score of 1 while a "no" response would elicit a score of 0 for that question. See image on the right.
The Opioid Risk Tool is a brief questionnaire meant to identify risk factors for opioid abuse before the initiation of opioid treatment. The Opioid Risk Tool is a score-based questionnaire where the higher a patient scores, the greater risk for opioid abuse. See the image below for the questions and scoring system.
B. Check CURES when initiating opioid therapy:
For detailed information regarding navigating the CURES program, download the CURES 2.0 user guide in pdf format.
Guidance for checking CURES:
• Per SB 482 (not in force at time of publication) prescriber should review patients medication history:
o No earlier than 24 hours before prescribing a schedule II, III, or IV drug to a patient for the first time.
o Once every 4 months after initial prescription if the drug remains part of their treatment plan.
• Exemptions include:
o Inaccurate or incomplete info in CURES
o For use only on facility premises
o Hospice care
o For surgical procedure (≤ 5 day non-refillable)
SB 482 was approved by the California Legislature in 2016, and will take effect after certification of CURES functionality; date to be determined.