Clinical Drug Monitoring in Primary Care
Brought to you by Quest Diagnostics and Practical Pain Management

Who to Monitor

How to Set the Stage for a Clinical Drug Monitoring Program with Your Patient with Jeff Gudin, MD

The conversation presented is simulated based on clinical experience.

The CDC guideline on opioid prescribing calls for clinicians to conduct a baseline urine drug test for any patient starting opioid therapy before they begin taking the prescription and to consider urine drug testing for those patients at least annually. Clinicians may want to test more frequently based on individual risk factors, periodically during routine visits, or when aberrant behavior is observed in a patient.

Consider drug monitoring any patient who:

  • is starting chronic opioid therapy or other controlled medication
  • is already taking prescribed opioids when they present for care
  • is undergoing a major change in rational pharmacotherapy
  • resists a full evaluation or presents with an unreliable/unavailable medical history
  • requests a specific controlled drug, even though it might be a valid request
  • displays aberrant behavior
  • exhibits mental health problems
  • drinks alcohol
  • has a history of or exhibiting a substance use disorder.

A best practice for determining potential prescription drug misuse or abuse in your patient may be to combine interviews and patient observations with one or more risk-assessment tools. In addition to urine drug testing, risk assessment tools may include the following:

  • Clinician-Administered:
    • COMM® (Current Opioid Misuse Measure)
    • DIRE (Diagnosis, Intractability, Risk, Efficacy)

Patient-Administered:

    • ORT (Opioid Risk Tool)
    • SOAPP-R® (Screener and Opioid Assessment for Patients with Pain)

How can I talk to my patient about drug monitoring?

Patients may be initially hesitant or sensitive to the concept of monitoring drug use, so knowing how to introduce the concept to them as part of your risk management plan will ease the process for you and your staff.

In these two simulated clinician-patient dialogues, pain management expert Dr. Jeff Gudin shows how a PCP can introduce the concept of drug monitoring to a patient without confrontation or the implication of stigma (watch the video), and how to communicate results to the patient (watch the video).

Also, consider sharing this downloadable FAQ about clinical drug monitoring with patients.

Key Takeaways
  • Clinicians should use urine drug testing for patients before prescribing opioid therapy and consider urine drug testing for those patients at least annually to assess for prescribed medications as well as for other controlled prescription drugs and illicit substances.
  • Certain risk factors can help determine whether to test a patient more frequently.
  • Knowing how to introduce the concept of drug monitoring to a patient as part of your risk management plan will ease the process for you and your staff.

 

Next up, How and What to Monitor

 

Last updated on: April 30, 2019
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