Guidelines recommend careful monitoring of patients on long-term opioid therapy for chronic pain to assess for concerning medication-taking behaviors that may signal opioid misuse or the presence of a substance use disorder. However, specific management strategies to guide providers if concerning medication-taking behaviors emerge are lacking. Therefore, we recruited a Delphi panel-42 experts in chronic pain and opioid prescribing-to develop consensus-based treatment approaches to guide management of the 6 most common and concerning behaviors identified: missing prescriber appointments, taking opioids for symptoms other than pain, using more opioid medication than prescribed, asking for an increase in opioid dose, aggressive behavior, and alcohol and other substance use. The results of that process are published as a separate study. The purpose of the present study was to present clinical cases in which concerning medication-taking behaviors arise in the course of long-term opioid therapy and demonstrate for readers how the Delphi panel's consensus-based approaches could be applied.
Keywords: CR, controlled release; DSM-5, Diagnostic and Statistical Manual of Mental Diseases (Fifth Edition); IR, immediate release; LTOT, long-term opioid therapy; OUD, opioid use disorder; PCP, primary care provider.