Validated UDS Risk Assessment Tool
UDS
Was the UDS ordered today?
Was the last UDS reviewed today?
Were there any aberrancies in the UDS today?
If aberrant, what was it?
Was the UDS ordered today random?
Was the UDS ordered today less then 90 day aberrancy?
Was the UDS ordered today baseline NP?
Patient is HIGH RISK: 1-3 UDS q 3 months (min 4-max 0 q yr)
60+ MME daily
History of Suicide Attempt of Major Psych Disorder
Taking a combination of Opiates and Benzodiazepines
Reasonable suspicion of diversion
Homeless or residing in a shelter
Resides with family or friends that are currently taking opiates or suffering with drug/alcohol addiction
History of Methadone of Suboxone Clinic
Diagnosis of Substance Use Disorder (DSM-5)
Hx of DRUG CONVICTION
Previous +ILLICIT drug
Tampered UDS SAMPLE
DISCHARGED from Previous Pain Clinic
Age YOUNGER than 45
Pt has been discharged from prior pain clinic
Behavioral outburst
Alcohol Dependency
Alcohol Use
Opiate overdose
History of Cocaine Use
Diagnosis of OUD
Anti-depressant overdose
Admits to buying narcotics of the street
Lives out of state
Hx of selling controlled substances
Admits to borrowing non rx opiates from friends/family
Diagnosis of Anxiety, depression or bipolar
History of psychosis
History of physical or psychological abuse
1 or more aberrancy in the past 12 months
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
Patient is LOW Risk: A minimum of 1 UDS every 6 months
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
Select the highest risk category checked above
High Risk
Moderate Risk
Low Risk
Substance Use Disorder
Substance Use Disorder (If yes, HIGH RISK: UDS required each visit)
Stage of Recovery
< 30 days abstinence
31-90 days abstinence
> 90 days abstinence
New Patient - Will assess at followup