Minimum+opiate+prescribing+guidelines


 * CCRMC Minimum guidelines for prescribing controlled substances for chronic (non-cancer) disorders **

When starting a controlled substance or continuing a prescription started by someone else, document the following at start or soon thereafter:
 * History and physical exam
 * Level and location of pain, activity level, other therapies tried
 * Personal or family history of mental health and substance abuse
 * Pain agreement and informed consent
 * Evaluation of risk. A patient may be considered high risk based on any of the following:
 * o ORT, DIRE or COMM risk score
 * o Combinations of controlled substances
 * o Dose of 100mg daily morphine equivalent or above
 * o High concern for recent/active substance abuse

Monitoring:
 * Utox yearly
 * Re-evaluate risk regularly
 * Re-evaluate pain level, substance abuse, activity level and effectiveness of medications regularly
 * Follow-up visits q3 months if higher risk or higher dose, q6 months if stable
 * CURES yearly strongly recommended
 * Strongly recommended to also address sleep and the 4 As (analgesia, activity, adverse effects, aberrant behaviors) at intervals

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