For Opioid Prescribing

  1. Two-Bottle Method: Medication compliance is difficult in any field of medicine. For example, a 10-d course of antibiotics is almost never finished on time. The 2-bottle method is a way to keep patients from unintentionally overtaking medications.
  2. Virtual Pill Count (2 pages) and Consent for Virtual Pill Counts: Pill counts to check for overtaking or diversion is often overly burdensome for patients. I pioneered the Virtual Pill Count to address this problem. In this age of ubiquitous cellphones with excellent cameras, this is a very feasible option.
  3. Witnessed Disposal Record: Sometimes patients have old prescriptions we need to make sure are disposed of. They can take them to take-back stations but you have no idea if they really did get rid of the medications. However, we are not allowed to take back medications – the DEA does not know what we did with the pills we took back. The witnessed disposal is a legal way for us to witness the destruction of unwanted pills.
  4. Pain Contingency Plan: This document is given to patients to let them know what to do if they need to have dental work, get hurt, or need to be hospitalized.
  5. Informed Consent for Concurrent Benzodiazepine+Opioid Therapy: Patients are strongly discouraged not to mix opioids with benzodiazepines. Sometimes, this combination is unavoidable, in which case, getting the patient to sign an informed consent will at least protect the prescriber, documenting that the patient has been fully informed of the risks.