Goals | Strategies | Comments | |
Stratification of risk | To clarify the likelihood of future aberrant drug-related behavior | Regard as high risk if:
Other factors that suggest risk:
Factors that can mitigate risk:
| All patients should undergo risk assessment and stratification; although many questionnaires have been developed to predict aberrant behavior or addiction, the clinical assessment is generally used in practice. |
Structuring of treatment commensurate with risk | Practices to match monitoring with risk, and when needed to help patients maintain control | Strategies include:
| The decision to implement one or more of these strategies is a matter of clinical judgment. |
Assessment of drug-related behaviors over time | Track drug use in tandem with all relevant outcomes | Monitor:
| Broad monitoring of outcomes is consistent with integration of pain management into a palliative care model. |
Response to aberrant drug-related behaviors | Clinician compliance with laws and regulations; identification of patients needing additional management | If the patient engages in aberrant drug-related behavior:
| Even advanced illness does not free the clinician from the requirement of compliance with laws and regulations. |
Documentation and communication | Risk assessment and management should be viewed as integral to safe and effective prescribing | Document:
| Open discussion of the need for universal risk management with other clinicians is valuable to reduce the risk of stigmatizing patients. |
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