Chapter 51 - Evaluation for Opioid Management: Opioid Misuse Assessment Tools and Drug Testing in Pain Management

Abstract

Chronic pain can impose a tremendous burden on the quality of life of those affected by this condition. Opioid analgesics provide effective treatment for pain, but many providers have concerns about adverse effects, tolerance, and addiction. Lax opioid prescribing practices in the past have contributed to an “opioid epidemic.” Early recognition of misuse risk could help providers offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this chapter, we define relevant terms, present information on the prevalence of prescription opioid misuse and addiction, discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic noncancer pain, examine the contributing role of negative affect in opioid misuse, and describe risk assessment tools that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic pain have significant medical, psychiatric, and substance use comorbidities that affect treatment decisions so and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no “gold standard” for opioid misuse risk assessment, several validated measures have been shown to be useful. Use of opioid therapy agreements, urine toxicology screens, prescription drug monitoring programs, and behavioral interventions in clinical practice can help minimize aberrant drug-related behavior. Finally, we discuss some future considerations surrounding opioid therapy and review the role of innovative technology to help guide healthcare providers in managing chronic pain patients who are prescribed opioids for pain.