Validated UDS Risk Assessment Tool
UDS
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Was the UDS ordered today?
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Was the last UDS reviewed today?
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Were there any aberrancies in the UDS today?
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If aberrant, what was it?
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Was the UDS ordered today random?
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Was the UDS ordered today less then 90 day aberrancy?
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Was the UDS ordered today baseline NP?
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Patient is HIGH RISK: 1-3 UDS q 3 months (min 4-max 0 q yr)
60+ MME daily
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History of Suicide Attempt of Major Psych Disorder
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Taking a combination of Opiates and Benzodiazepines
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Reasonable suspicion of diversion
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Homeless or residing in a shelter
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Resides with family or friends that are currently taking opiates or suffering with drug/alcohol addiction
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History of Methadone of Suboxone Clinic
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Diagnosis of Substance Use Disorder (DSM-5)
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Hx of DRUG CONVICTION
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Previous +ILLICIT drug
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Tampered UDS SAMPLE
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DISCHARGED from Previous Pain Clinic
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Age YOUNGER than 45
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Pt has been discharged from prior pain clinic
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Behavioral outburst
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Alcohol Dependency
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Alcohol Use
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Opiate overdose
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History of Cocaine Use
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Diagnosis of OUD
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Anti-depressant overdose
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Admits to buying narcotics of the street
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Lives out of state
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Hx of selling controlled substances
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Admits to borrowing non rx opiates from friends/family
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Diagnosis of Anxiety, depression or bipolar
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History of psychosis
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History of physical or psychological abuse
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1 or more aberrancy in the past 12 months
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Patient is MODERATE Risk: A minimum of 1 UDS every 3 months
No Objective Date for Pain (Including Fibromyalgia)
20-59 MME daily
Multiple prescribers, multiple pharmacies at initial OV
Associated with patient in this clinic
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Patient is LOW Risk: A minimum of 1 UDS every 6 months
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​No Hx of Abnormal CSR
No Hx of Abnormal UDS
No Behavioral or PE abnormalities
Less than 20 MME
No previous alcohol or drug abuse
No Psych Hx
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Select the highest risk category checked above
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High Risk​
Moderate Risk
Low Risk ​
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Substance Use Disorder
Substance Use Disorder (If yes, HIGH RISK: UDS required each visit)
Stage of Recovery
< 30 days abstinence
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31-90 days abstinence
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> 90 days abstinence
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New Patient - Will assess at followup
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