Section 20-2-V - General CaveatsA.Extreme Caution NeededExtreme caution should be used when prescribing opioids for patients with one or more of these issues:
1. history of alcohol or other substance abuse;2. chronic benzodiazepine use;3. uncontrolled sleep apnea; 4. severe personality disorder or other known severe psychiatric disease;5. decreased physical and mental function with continued opioid use; and6. addiction behaviors including preoccupation with drugs, strong preference for short-acting over long-acting opioids, use of multiple prescribers/pharmacies, use of street drugs or other patient's drugs, not taking medications as prescribed, losing medication on more than one occasion, and criminal behaviors such as forged prescriptionsB.Warning Signs of AddictionThe following behaviors, frequently seen in patients who abuse prescription drugs, are warning signs for addiction:
1. unusual knowledge of controlled substances;2. request for specific controlled substances;3. claims to allergies to multiple medications;4. demanding assessment of medication after usual clinic hours;5. requesting refills because of loss or stolen medications;6. physical signs of drug abuse;7. no interest in the diagnosis;8. failure to keep treatment or consultation appointments;9. feigning or exaggerating physical problems;10. pressuring the physician by eliciting sympathy, guilt or direct threats;11. subjective complaints exceeding objective findings; and12. attempts to transfer care after a doctor refuses to fill a prescription for a habit-forming medication.C.Prescription Monitoring ProgramThe clinician shall review the patient's history on the state's Prescription Drug Monitoring Program whenever opioids are prescribed . The review (or the attempt to review the PMP if it cannot be accessed due to technical difficulties) should be documented or made part of the medical record.