FOLLOW-UP URINE DRUG SCREEN/ ABERRANT BEHAVIOR TEMPLATE Do Tran, Pharm.D .

1. FOLLOW-UP URINE DRUG SCREEN/ ABERRANT BEHAVIOR TEMPLATE Do Tran, Pharm.D. 1Pharmacy Service, Northern California Health Care System (NCHCS); 2Dietary Service (NCHCS), 3Nursing Service, (NCHCS); , 4Medicine Service, (NCHCS), 5Mental Health Service, (NCHCS), 6Veterans Integrated Service Network (VISN) 21 Pharmacy Benefits Management Introduction Methods Results • Template to include the following functions: • Optional clinical reminder if there is a positive urine drug screen result • Indication if there is an opioid contract/agreement on file • A list of positive urine drug screen, which also include oxycodone result • A list of current prescribed controlled medications • A reference section which includes information on false positives and detection time in urine • Option to schedule follow-up appointment • Plan to include various options such as: discontinuation, tapering, non-pharmacologic modalities, SATP (substance abuse treatment program) and non-opioids • A list of non-pharmacologic modalities for provider to choose from, which will take the provider to the appropriate consult. The non-pharmacologic modalities to include: acupuncture, chiropractic, PT, behavior health, etc… • A list of non-opioid medications is available for provider to choose from, this includes initial dose and an option to change the dose. • There is a free text option for provider to enter their plan, if the available pre-populated plan option does not meet the situation • There is no standardization for providers to follow when there is a urine drug screen result not consistent with prescribed narcotic regimen and/or patient exhibiting aberrant behavior. • Often time providers forget that a urine drug screen was ordered and forget to follow up on UDS results. • The lack of guidelines and standardization of positive urine drug screen result not consistent with prescribed narcotic regimen creates an environment for patients to continue to misuse or abuse prescribed narcotics. • The lack of standardization and guidelines create a “provider shopping” environment. Patients who are abusing narcotics will tend to gravitate toward a more lenient provider. • These group of patients utilize a large amount of resources from our health care system. They create disruption at the clinic and go to great length in seeking more narcotics. Conclusion This template is available in our cprs under the title: uds follow-up. Hopefully this template will provide a consistent message to the patient. It is being promoted throughout our Northern California Health Care System through the PACT initiative. Objective • To tackle this issue, our local pain committee feels that the best way to standardize this and provide guideline is through a template. The template would have to be simple, easy to read and use, and with a “one stop shopping” approach.