||Before initiating opioid therapy, ensure comprehensive documentation of the patient’s pain condition, general medical condition and psychosocial history (Grade C), psychiatric status, and substance use history. (Grade B).
||Before initiating opioid therapy, consider using a screening tool to determine the patient’s risk for opioid addiction. (Grade B).
||When using urine drug screening (UDS) to establish a baseline measure of risk or to monitor compliance, be aware of benefits and limitations, appropriate test ordering and interpretation, and have a plan to use results. (Grade C).
||Urine drug screening
||Before initiating opioid therapy, consider the evidence related to effectiveness in patients with chronic non-cancer pain. (Grade A).
||Before initiating opioid therapy, ensure informed consent by explaining potential benefits, adverse effects, complications and risks (Grade B).
A treatment agreement may be helpful, particularly for patients not well known to the physician or at higher risk for opioid misuse. (Grade C).
||For patients taking benzodiazepines, particularly for elderly patients, consider a trial of tapering (Grade B). If a trial of tapering is not indicated or is unsuccessful, opioids should be titrated more slowly and at lower doses. (Grade C).