Assessing risk prior to therapy   Structuring therapy at the outset   Using an opioid contract   Establishing a diagnosis   Responding to problematic behavior

Risk Assessment and Management Strategies

Opioids are potentially abusable drugs, and the monitoring and management of the risks associated with abuse, addiction and diversion are elements of therapy. Clinicians who prescribe opioids for chronic pain are obligated to understand regulations and laws governing use of controlled substances and to implement strategies related to the risk of abuse that appropriately address the clinical risk.

The critical elements in this process include:

• Assessing risk prior to therapy
• Structuring therapy at the outset to ensure a degree of monitoring and control that is commensurate with risk
• Using an opioid contract
• Establishing a diagnosis
• Responding to problematic behavior over time in a manner that follows the diagnostic formulation, reduces risk, and optimizes therapy