PROVIDER SERVICES
Empowering providers with the data, tools, and guidance needed to make every treatment decision with confidence.
Our service and support tools enable our clinicians to make the best treatment decision with confidence.
Essential Tools
A. Risk Assessment Tools for Patients Prescribed Opioids
All Patients
- Risk-assessment tool, Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R) or other:
- Opioid Agreement
- Treatment goals clearly defined
- Urine or hair drug test* at first visit
- Urine or oral drug tests appropriate for risk level
- Check state’s Prescription Drug Monitoring Program (PDMP) before every opioid prescription
- Consider medication counts
In-Office Drug Screening:
- If a provider chooses to use a Point of Care Testing (POCT) cup or has an immunoassay analyzer, they should consider the following:
- Sensitivity, specificity and cutoff levels
- Ordering an adulterant panel or sending to a reference lab for an adulterant panel
- Sending positive and unexpected results to a reference lab for confirmation on LS/MS/MS or GC/MS technology
- Drug and drug classes that may not be detected with in office testing, include these:
- You may want to consider sending these drugs to your reference lab for direct testing: Fentanyl, Meperedine, Gabapentin, Buprenorphine, Tramadol, Bath salts, Carisoprodol, Syools for Patients Pres Opioids
B. Drug-Testing Frequency Schedule All Patients:
- Low risk: periodic (e.g. up to 2/year)
- Medium risk: regular (e.g. up to 4/year)
- High risk or opioid >100mg MED/d: frequent (at least 4/year, up to as frequently as every visit)
- Aberrant behavior: at the time of each visit
C. Drug Screening Matrix Considerations
Urine:
- 2-3 Days Most widely used, but easiest to “beat.” Used for routine drug monitoring
Oral Screening:
- Up to 48 Hours Detects more recent use; noninvasive sample that is difficult to adulterate and easy to collect. Ideal sample for drug monitoring in chronic opioid treatment.
Blood Hours:
- Best sample for measuring pharmacologically active drug levels and provides interpretive information about drug dosing and tolerance. More invasive collection, but blood is ideally suited to periodically check steady-state drug concentrations.
D. Unexpected Results
Unexpected results can occur for a number of reasons, including PRN use of medications, forgetfulness, or breakthrough pain episodes. Always discuss results with the patient before determining results as aberrant.
Potential behavioral flags include the following:
- Illicit drugs
- Alcohol
- Negative result on prescribed medications
- Positive for other medications (not disclosed)
Matrix Detection Window Clinical Use Urine 2-3 Days Most widely used, but easiest to “beat.” Used for routine drug monitoring.
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