What is the best approach when a patient with recent trauma requests additional opioid prescriptions?

• A. Review the medical record
• B. Determine which drugs have been prescribed for the patient in the past
• C. Discuss nonpharmacologic options
• D. Refer to psychiatry

Answer: (B)

When a patient with recent trauma asks for more opioids, the most important first step is to determine which drugs have been prescribed for the patient in the past. This history reveals prior opioid exposure, patterns of use, and potential risk factors such as tolerance, dependence, or misuse. It helps you gauge how aggressive a plan would be, whether there are red flags like frequent refills or high doses, and what alternatives might be safer. Checking past prescriptions also often involves reviewing the prescribed medications already in the patient’s chart and, when available, data from a prescription monitoring program to get a complete picture.

While reviewing the medical record is helpful, pinpointing the patient’s past opioid prescriptions specifically targets the key risk information needed to guide safer decisions. Discussing nonpharmacologic options is an important part of multimodal pain management, but it doesn’t directly address the immediate risk assessment involved with requests for more opioids. Referral to psychiatry is not routinely indicated unless there are signs of an opioid use disorder or other complex psychiatric issues.