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Unsafe opioid prescribing and OUD assessment — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareUnsafe opioid prescribing and OUD assessmentUSMLE Step 3

A 51-year-old man with chronic noncancer pain asks for an early opioid refill for the third time in 2 months. He reports lost pills. PDMP shows opioid prescriptions from two urgent care clinics. Urine drug testing is negative for the prescribed opioid and positive for cocaine. Which of the following is the most appropriate next step in management?

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Correct answer: A — Reassess for opioid use disorder, discuss safety concerns, and offer evidence-based treatment

Concerning opioid-related behaviors should trigger nonjudgmental reassessment, safety planning, and evaluation for opioid use disorder with treatment such as buprenorphine when indicated. Patient abandonment and dose escalation are inappropriate.

Reference: CDC Opioid Prescribing Guideline 2022; ASAM Opioid Use Disorder Guideline