TIME TO REFER

CDC Recommendation

• If a patient’s dosage has increased to ≥ 120 morphine milligram equivalents per day without substantial improvement in pain and function, seek a consult from a pain specialist.
• The CDC has published a brochure on Unintentional drug poisoning in the United States. 
  

Click here for CDC Brochure in PDF

Consider referral to a Pain Medicine Specialist in the following situations:

• Patient with complex pain conditions or polytrauma
  
• Patient with significant medical comorbidities that may negatively impact opioid therapy
  
• Patient who is unable to tolerate increased pain or physical withdrawal symptoms arising from opioid tapering when opioid therapy is being discontinued
  
• Opioid induced hyperalgesia or opioid tolerance is suspected
  
• High dose of medication (greater than 200 mg/day morphine equivalents) provides no further improvement in function
  
• Patient requiring management beyond the expertise of the primary provider
  

Consider Referral to/consultation with a Behavioral Health Provider for evaluation and treatment in the following conditions:

• Exacerbation of an underlying psychotic disorder
  
• Uncontrolled, severe psychiatric disorder or those who are emotionally unstable
  
• Demonstration of high-risk behaviors suggestive of suicide ideation
  
• Psychosocial problems or comorbidities that may benefit from disease or case management
  
• Adverse behavioral or cognitive effects of opioid therapy
  
• Co-occurring trauma related conditions (mTBI, TBI, PTSD)