Below you will find several opioid misuse algorithms. Click on the opioid misuse behavior to reveal the relevant algorithm. Please be cognizant that these algorithms are guides, not rules. Please use your best clinical judgment on all questions pertaining to opioid misuse, and always consider the context of the situation and any differential diagnoses.
Algorithms
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Missing appointments with the provider who is prescribing the opioid
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Taking opioids for symptoms other than pain
(e.g., for anxiety, depression, sleep, or to produce euphoria)
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Using more opioid medication than prescribed
(e.g., unsanctioned dose escalation, early refill requests, running out of medication early)
- Download PDF
Discussing non-opioid therapies
Switching to buprenorphine
Tapering guidance -
Asking for an increase in opioid dose
(i.e. demanding or repeatedly asking)
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Alcohol use
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Download PDF
Tapering guidance
NIAAA alcohol screening question (PDF) -
Other substance use
(cocaine, methamphetamine, benzodiazepines, heroin)
