Risk Assessment Tools

When a pain or dyspnea assessment indicates the need for opioids for symptom management, a risk assessment tool can be used to help to identify those people who are more likely to struggle or be struggling with addiction issues. Identifying these people before beginning opioids can help the health care team safely manage their opioid use.

Four standardized tools are available at the website https://Opioidrisk.com. The tools vary from a 1 minute self-report to a 5 minute interview tool, offering a range of ways to assess the risk of opioid misuse.

Tell us about the tools that you use in your location. How are they different? Please post into the comments section, if possible.

Contracts and Agreements for Safe Opioid Use

Part of process for initiating opioids could include the discussion and signing of a contract, clearly outlining the person’s responsibilities for safe opioid use, including storage and disposal of medications. The contract facilitates the discussion around safe opioid use and will help establish the parameters required for safe opioid use in the home.

What types of contracts or users agreements for opioid use are you familiar with? Are they used before beginning opioids? Please add your document/contract or link it into the comments here. It would be interesting to see what is used for ensuring safe opioid use in different locations in Canada and the USA.

Tell us your thoughts on this contract linked here. Which parts are helpful and which parts don’t you like?

Sample User Agreement

Guidelines for Prescribing Opioids for Chronic Pain

2017 Canadian Guidelines for Opioid Use for Chronic Pain

Opioids -How to Use Them Safely

Guidelines for Storage and Disposal

Completing a risk assessment and contract with the person receiving the opioids can help facilitate safe opioid use. Including the following key steps (from www.healthcareprovidersolutions.com) when handling opioids will help decrease the risk of misuse and diversion:

• Counting controlled substances at each visit for each patient, regardless of the risk of diversion in their home.  This practice is helpful for many reasons not just identification of possible diversion but may help to identify diversion early.

• Limiting the supply of controlled substances.  In situations where diversion is known or suspected, daily deliveries of the controlled substances needed by the patient may be made or limiting the supply to just a couple of days is implemented.

• Limiting access to the controlled substances.  This may be in the form of a lock box in the patient’s home with only certain individuals and hospice staff having access.

• Working with the patient and family to relocate the patient to a more controlled environment such as a nursing home or hospice inpatient unit.

Health care providers need to know how to safely dispose of opioids. The following are guidelines developed for health care providers in the USA for disposing of opioids. Check for specific policies and procedures at your location.

Resources for Safe Opioid Use by Health Care Professionals and Family

Institute for Safe Medication Practices Canada – Opioid Stewardship – Brochures and downloads available

Fraser Health: Principles of Opioid Management – with specifics of safe handling and disposal of fentanyl patches

Four Strategies for Managing Opioid Side Effects

Strategies for Harm Reduction

Implementing any of these strategies for harm reduction may be helpful in reducing the current opioid crisis. Consider how to respond to people experiencing addiction with compassion and to support them in their rights to equal health care.

Canadian Nurses Association – Harm Reduction

BC Nurses Union – Position Statement on Harm Reduction

Compassionate Care for People with Addictions

Update of blog originally published in 2017