Consumer & Opioid User Survey Instrument
This survey asks about prescription opioids, which are powerful medicines that healthcare providers can prescribe for severe pain. Most of the questions in this survey ask about prescription opioids that are used for pain not caused by cancer. Examples of prescription opioids include codeine, hydrocodone (Norco, Vicodin), oxycodone (OxyContin, Percocet), morphine, and fentanyl.
Asked of all three groups
1. For each of the following statements, indicate whether you think it is true or false or if you are not sure. It’s okay to say you are not sure if that is the case. (true/false/not sure)
Prescription opioids are narcotic medicines. (T)
Marijuana is an opioid. (F)
Codeine is an opioid. (T)
Heroin is an opioid. (T)
Medical research shows that opioids work well to relieve long-term pain in patients who take them for pain not caused by cancer. (F)
The most common way to abuse prescription opioids is through crushing and snorting the pills. (F)
Only people who use prescription opioid medicines to get high become addicted to them. (F)
Tolerance is a condition where higher doses of a drug are needed to get the same effect over time. (T)
The chances that someone may become addicted to prescription opioids increases if they take them for more than 5 days. (T)
Overdosing on opioids always results in death. (F)
A patient who takes their opioids exactly as prescribed by their healthcare provider will not become addicted to them. (F)
Heroin kills more people every year than prescription opioids. (F)
More people get prescription opioids by taking them from a family member or a friend who has a prescription than buying them from street dealers. (T)
People with a history of mental health issues may be more likely to become addicted to opioids. (T)
Patients taking a specific kind of prescription opioid called an abuse-deterrent form cannot become addicted to it. (F)
Addiction is a disease that can be treated by medicines. (T)
Opioid addiction happens mostly to younger people. (F)
Not all prescription opioids are addictive. (F)
Asked of all 3 groups
2. How much do you agree or disagree with each of the following statements about opioid addiction? (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Opioid addiction is a long-term chronic disease.
Like other chronic diseases such as diabetes and heart disease, opioid addiction should be treated with medicines that a person may need to take for a long time or forever. People addicted to prescription opioids do not seek treatment because they worry they will be called an “addict.”
People addicted to prescription opioids do not seek treatment because they don’t know where to find help.
People addicted to opioids do not seek treatment because they cannot afford it.
People addicted to opioids do not seek treatment because it’s not covered by their insurance.
People addicted to opioids do not seek treatment because they worry family members or friends will disapprove.
People addicted to opioids do not seek treatment because they worry about how it will affect their jobs.
There aren’t enough addiction treatment centers to treat everyone who is addicted to opioids.
The healthcare provider who prescribes an opioid should also have enough training to be able to treat a patient who becomes addicted to it.
Opioid addiction is a public health problem that entire communities should be involved in helping to solve.
Asked of all 3 groups
3. How much do you agree or disagree with each of the following statements? (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Use of opioids for more than 3 months can lead to changes in a patient’s behavior and personality.
Most patients who become addicted to prescription opioids lack self-control.
Healthcare providers do not want to change how they prescribe opioids.
Patients taking opioids for long-term chronic pain not caused by cancer (non-cancer pain) are not willing to try non-drug treatments.
It is appropriate for medical marijuana to be used instead of opioids to treat long-term chronic non-cancer pain.
Enough different kinds of opioids are already available on the market to treat pain.
Efforts to reduce prescription opioid abuse will make it harder for patients who have chronic long-term non-cancer pain to get these medicines.
Warning labels on prescription opioid bottles that explain the risk of addiction would reduce the abuse of prescription opioids.
The risks of abuse, addiction, and overdose outweigh the benefits of using opioids to treat pain.
Patients taking opioids for long-term chronic non-cancer pain do not try non-drug treatments because their healthcare providers do not prescribe them.
If one healthcare provider will not prescribe opioids for long-term chronic non-cancer pain, a patient will go to another provider to get them.
Non-drug treatments can reduce the need for prescription opioids for long-term chronic non-cancer pain.
Drug company representatives should continue to be allowed to talk directly to healthcare providers about the opioid medicines their companies are selling.
No new opioids should be allowed to be sold unless they are proven to be non-addictive.
Having an adult with an addiction to opioids or other substances in a home increases the chances that a child will have later substance-abuse problems.
People prescribed opioids for pain usually do not throw any extras away because they think they or their family members might need them in the future.
Asked of all 3 groups
4. In general, how often do you think each of the following occurs when prescription opioids are used to treat long-term chronic non-cancer pain? (7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
Misuse (taking more of an opioid or more often than prescribed in order to treat the pain)
Abuse (taking more of an opioid in order to get high)
Physical dependence
Addiction
Withdrawal
Overdose
Patient requesting prescription opioids before a refill is due
Patient receiving opioid prescriptions from multiple healthcare providers at the same time
Patient sharing prescription opioid medicines with family members or friends
Patient uses alcohol while taking prescription opioids
Patient uses recreational marijuana while taking prescription opioids
Prescription opioids leading to the use of stronger prescription opioids such as fentanyl
Prescription opioids leading to the use of illegal drugs such as heroin
Asked of general consumers and ever users (Chronic opioid users questions is below)
5. How much do you agree or disagree with each of the following statements about abuse-deterrent forms of opioids (ADFs)? ADFs are medicines created to help lessen the chance of abuse, for example by making it harder to crush or melt pills in order to snort or inject them to get high. (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
If more patients used ADFs, there would be fewer cases of abuse.
ADFs prevent patients from becoming addicted to opioids.
ADFs can reduce deaths from prescription opioids.
ADFs don’t decrease abuse, it is just a marketing tool.
Healthcare providers only prescribe ADFs to patients they think will abuse their opioids.
Asked of general consumers and ever users (Chronic opioid users questions is below)
6. How much do you agree or disagree with each of the following statements about Medication Assisted Treatments (MATs)? MATs are medicines used to treat abuse of opioids and other substances. (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Using MATs such as methadone to treat people addicted to opioids is replacing one addiction with another.
MATs help decrease opioid addiction.
MATs prevent patients who are abusing or addicted to prescription opioids from using street drugs like heroin.
MATs prevent patients who are abusing or addicted to prescription opioids from using stronger prescription opioids.
MATs allow patients addicted to prescription opioids to continue to work.
MATs allow patients addicted to prescription opioids to continue to keep good personal relationships.
MATs allow patients addicted to prescription opioids to focus on things other than getting “high.”
MATs decrease drug-related crimes.
MATs decrease HIV/AIDS and other diseases transmitted through sharing needles.
More healthcare providers who prescribe opioids should be trained to prescribe MATs to treat patients who become addicted.
Asked of all 3 groups
7. How much do you agree or disagree with each of the following statements about opioid-reversal drugs (ORDs)? ORDs are medicines that block the effects of an opioid and help prevent death from an overdose. (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
ORDs encourage people to abuse or misuse opioids.
ORDs prevent people who abuse opioids from getting treatment.
ORDs prevent people with an opioid addiction from seeking treatment.
ORDs are important to reduce deaths from the opioid epidemic.
It is important that anyone who has an opioid prescription also has a prescription for an ORD.
(Asked of all 3 groups)
8. How much do you know about each of the following? (7-point scale: Nothing at all, Very little, A little, Some, A moderate amount, A large amount, A very large amount)
Abuse-deterrent opioids (medicines created to help lessen the chance of abuse, for example by making it harder to crush or melt opioid pills in order to snort or inject them to get high)
Opioid-reversal drugs (medicines that block the effects of an opioid and help prevent death from an overdose)
Medication-assisted treatment (medicines used to treat abuse of opioids and other substances)
Asked of all 3 groups
9. How much do you agree or disagree that each of the following would be effective things that healthcare providers could do to reduce patient misuse and abuse of prescription opioids. (7-point scale: Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Ask if the patient has ever been addicted to or abused any substances (for example, alcohol or drugs)
Set realistic goals for relieving a patient’s pain
Review a patient’s current and past prescriptions for opioids
Ask the patient if they can do their everyday activities
Have the patient read and sign a written opioid treatment contract
Conduct urine drug screens for both legal and illegal drugs at appointments
Ask the patient to bring their pills to their office visits to count the number of pills left
Require an office visit to get a refill for their opioid prescription
Prescribe an abuse-deterrent form (ADF) of the opioid. ADFs are created to help lessen the chance of abuse, for example by making it more difficult to crush or melt opioid pills to snort or inject them to get high
Prescribe a limited number of opioid pills at first to see how the patient handles them
Ask about current and past mental health problems
Schedule monthly visits to make sure that the opioids are working to reduce pain and helping to meet the patient’s goals for treatment
Check to see if the patient has received opioids from other healthcare providers or several pharmacies
Asked of ever users only (Chronic opioid users questions is below)
10. The last time you were prescribed an opioid, which of the following did your healthcare provider talk with you about? (Response options: Yes, No, Not sure)
Possible drowsiness
Not to drive or operate other heavy machinery
Not to make important decisions
Possible breathing problems
Possible constipation
Potential feeling of euphoria (feeling “high”)
Possible addiction to or dependency on the drug
How to safely store opioid pills so others could not get hold of them
How to get rid of any extra pills after the pain is gone
If you were taking any other opioids or pain medicines
If you were taking any prescription medicines to treat anxiety, sleep problems, or seizures
If you were taking any non-prescription medicines, vitamins, or herbal remedies or supplements
If you drink alcohol
If you use marijuana
If you use any illegal drugs or any drugs that were not prescribed to you, such
Serious side effects when combining the opioid with alcohol, marijuana, or illegal drugs
If you had any history of problems with drugs or alcohol
If you had ever overdosed with an opioid or another drug
Asked of chronic opioid users and ever users
11. How much information did you receive or would you have liked to receive about each of the following from the healthcare provider treating your pain? (Response options: I did not receive any information about this; I would have liked more information; The amount of information was right for me; I would have liked less or no information)
Your illness or injury
The cause(s) of your pain
How the opioid being prescribed could help you
How and when to take the opioid
Possible side effects of the opioid
Risks/concerns about abuse and addiction
Warning to take the opioid only as prescribed with no dose or schedule changes
How long you should expect to take the opioid
How to know whether the opioid worked
Not to share your opioid medicine with others
How to store the opioid safely
How to properly dispose of the opioid
Interactions of the opioid with other medicines you are taking
What other information would you like to have received? (write in)
Asked of chronic opioid users and ever users
12. Which of the following types of printed information did your healthcare provider give to you about the opioid you were prescribed? (Response options: Yes, No, Not sure)
General information about opioids
Specific information about the opioid you were prescribed
Information from your electronic medical record or the healthcare provider’s computer
Information from a government agency like the Centers for Disease Control and Prevention (CDC) or the Food and Drug Administration (FDA)
Information from a website, such as WebMD
Information or brochures from a drug company
The patient medication guide for the specific drug you were prescribed
A list of resources for more information about opioids, such as websites and articles
Opioid education materials developed by a medical association or nonprofit organization
A list of things that could help reduce pain such as physical exercises, or breathing or relaxation practices
Other (write in)
Asked of all general consumers and ever users
13. Have you ever known anyone who has taken prescription opioids for non-cancer pain that lasted longer than one month? Select one answer.
No (Skip next two questions)
Yes, a family member
Yes, a significant other
Yes, a friend
Yes, a coworker
Yes, other (specify)
Asked only of general consumers and ever users who answer yes to #11
14. Thinking about the person you just identified, did you ever have concerns about their use of these opioid medicines? Select one answer.
No (Skip next question)
Yes
Asked only of general consumers and ever users who answer yes to #12
15. Thinking about the person you just identified, how much were you concerned about each of the following related to their use of prescription opioids for pain not caused by cancer (non-cancer pain)? (Not at all, Very little, A little, Some, A moderate amount, A large amount, A very large amount)
The opioid was not controlling their non-cancer pain.
They took more opioids than prescribed or more often than prescribed.
They drank alcohol while taking prescription opioids.
They took opioids with other prescription medicines.
They took opioids with other non-prescription drugs such as marijuana or heroin.
They gave their opioids to other people to take.
They felt like they could not get through the day without the opioids.
They needed a refill of the opioids before one was due.
They had to have higher doses of opioids prescribed to them to manage their non-cancer pain.
They received opioid prescriptions from more than one healthcare provider at the same time.
They wouldn’t agree to see a pain specialist their healthcare provider referred them to.
They did not want to try non-drug ways to help manage their non-cancer pain such as physical therapy.
That they might be getting addicted to their opioids.
That they were having withdrawal symptoms.
That they might overdose on the opioid.
That their behavior might be changing because of the opioids.
That a child or teenager might find the opioids and take them.
That problems at work might be because of the opioids.
That problems at home might be because of the opioids.
That they might switch to an illegal drug such as heroin or cocaine.
That they were addicted to their opioids and needed treatment
Asked of all 3 groups
16. To what extent do you agree or disagree with each of the following statements about what FDA’s role should be in addressing problems related to opioids? (7-point scale: Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
FDA should:
Increase the safety requirements for new opioids before approving them.
Require that all opioids be developed in ways that makes them abuse-deterrent and lowers the chance of abuse.
Limit which patients can be prescribed opioids to only those that have certain medical problems such as cancer.
Limit how many doses of an opioid can be prescribed based on a patient’s medical problem.
Provide training and education to healthcare providers about the safe use of prescription opioids.
Provide information and education to the public about the safe use of prescription opioids.
Other (write in)
Asked of all 3 groups
17. If you wanted information about an opioid medicine you were prescribed or were taking, from which of the following would you like to receive it? (Check all that apply.)
Federal websites
My patient portal from my healthcare provider’s office
Drug websites
WebMD
A conversation with my healthcare provider
Written instructions from my healthcare provider
A conversation with a pharmacist
Written instructions from a pharmacy
Online discussion group with other patients taking opioids
Patient group at my local hospital or other healthcare location
Other (write in)
Asked of all 3 groups
18. How would you like to get this information about opioids? Choose all that apply.
Videos
Podcasts
Fact-sheets
Check lists
Information posted on websites
Links to online resources
Text messages
Printed brochures
Other (open)
I do not want any information on opioids.
Both ever users and chronic users
19. To what extent have you personally experienced each of the following while taking opioids for non-cancer pain? (7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
The opioid didn’t reduce your pain.
You took more of the opioid or more often than prescribed in order to treat the pain.
You took more of an opioid in order to get high.
You requested more pain medicine before a refill was due.
You shared your prescription pain medicine with family members or friends.
Your prescribed opioid fell into the wrong hands (children, teens).
Your opioids were stolen.
You used alcohol while you were being treated with opioids.
You used recreational marijuana while you were being treated with opioids.
You used illegal drugs such as heroin while you were being treated with opioids.
All 3 groups
20. We are interested in how to best explain abuse deterrent opioids to people. Abuse-deterrent forms of opioids (ADFs) are medicines created to help lessen the chance they will be abused. For example, ADFs can make it harder to crush or melt opioid pills in order to snort or inject them to get high. This does not mean it is impossible to abuse these opioids, and they still have the potential to be addictive.
How much do you agree or disagree with how well you think each of the following terms explains the idea of abuse-deterrent opioids (7-point scale: Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Crush-proof
Abuse-resistant
Tamper-resistant
Abuse-preventive
Abuse-averting
Abuse-avoiding
Abuse-reducing
Locked
21. What other descriptions or terms do you think would best describe ADFs? (write in)
Very last question for all 3 groups:
Do you have any comments you would like to share with the FDA about this topic? (Write in)
The FDA greatly appreciates your participation in this survey. Your answers will help us better understand peoples’ thinking about this important topic.
Both ever users and chronic users
22. How much you agree or disagree with each of the following statements about the overall experience you have had when seeing your healthcare provider for treatment for your non-cancer pain? (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
My healthcare provider and I discussed using opioids to treat my pain before they were prescribed.
My healthcare provider gave me information about all the available pain treatment options.
My healthcare provider and I made all treatment decisions together.
My healthcare provider’s explanations about treating my pain were easy to understand.
My healthcare provider gave me enough information about the risks and side effects of taking opioids.
My healthcare provider made me feel comfortable asking questions about opioids.
My healthcare provider gave me enough time to talk about all my concerns related to opioids.
My healthcare provider gave me all the information I needed about the opioids.
Overall, I am satisfied with my discussions with my healthcare provider about how to treat my pain.
Overall, I am satisfied with my discussions with my healthcare provider about opioids.
Asked of ever users only (Chronic opioid users questions is below)
23. For how long did you take/have you been taking the opioid pain medicine? Select one answer.
A few days
One week
More than 1 week to 1 month
More than 1 month to 3 months
1–3 months
More than 3 months
XXXXX Next set of questions is for chronic opioid users only XXXXX
Asked of chronic opioid users
24. How much do you agree or disagree with each of the following statements about abuse-deterrent forms of opioids (ADFs). ADFs are created to help lessen the chance of abuse, for example by making it harder to crush or melt opioid pills in order to snort or inject them to get high. (7-point scale: Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
If more patients used ADFs, there would be fewer cases of misuse and abuse.
ADFs can reduce deaths and other problems from prescription opioids.
ADFs prevent patients from becoming addicted to opioids.
ADFs are not available for many opioids that patients are taking for long-term chronic non-cancer pain.
Healthcare providers only prescribe ADFs to patients they think will abuse their opioids.
ADFs aren’t covered by most health insurance.
ADFs can only be prescribed by pain specialists.
ADFs are more expensive than non-ADF opioids.
ADFs don’t work as well as non-ADF opioids.
ADFs don’t decrease abuse, it is just a marketing tool.
Asked of chronic opioid users
25. How much do you agree or disagree with each of the following statements about Medication Assisted Treatments (MATs)? MATs are medicines used to treat abuse of opioids and other substances. (Strongly disagree, Disagree, Somewhat disagree, Neither agree nor disagree, Somewhat agree, Agree, Strongly agree)
Using MATs such as methadone to treat people addicted to opioids is replacing one addiction with another.
MATs are effective in reducing opioid addiction.
MATs prevent patients who are abusing or addicted to prescription opioids from using street drugs like heroin.
MATs prevent patients who are abusing or addicted to prescription opioids from using stronger opioids like fentanyl.
MATs allow patients addicted to prescription opioids to maintain a steady daily dose of opioids without the need to increase doses.
MATs allow patients addicted to prescription opioids to continue to work.
MATs allow patients addicted to prescription opioids to continue to keep good personal relationships.
MATs allow patients addicted to prescription opioids to focus on things other than getting “high.”
MATs allow patients addicted to prescription opioids to be safely maintained indefinitely on these medicines.
MATs decrease drug-related crimes.
MATs decrease HIV/AIDS and other diseases transmitted through sharing needles.
Overdoses from MATs are common.
Patients can safely take MATs to treat addiction their entire lives.
When answering the next set of questions, think about the healthcare provider who prescribed the opioids you are currently taking for long-term chronic pain not caused by cancer (non-cancer pain).
Asked of chronic opioid users
26. The first time your healthcare provider prescribed the opioid you are currently taking for long-term chronic pain not caused by cancer (chronic non-cancer pain), did she/he discuss any of the following with you? (Response options: Yes, No, Not sure)
Possible drowsiness
Not to drive or operate other heavy machinery
Not to make important decisions
Possible breathing problems
Possible constipation
Potential feeling of euphoria (feeling “high”)
Possible addiction to or dependency on the drug
How to safely store opioid pills so others could not get hold of them
How to get rid of any extra pills after the pain is gone
If you were taking any other opioids or pain medicines
The lack of medical evidence for the long-term effectiveness of opioids to control chronic non-cancer pain
If you were taking any prescription medicines to treat anxiety, sleep problems, or seizures
If you were taking any non-prescription medicines, vitamins, or herbal remedies or supplements
If you drink alcohol
If you use marijuana
If you use any illegal drugs, such as heroin or cocaine, or any drugs that were not prescribed to you?
Serious side effects when combining the opioid with alcohol, marijuana, or illegal drugs
If you had any history of problems with drugs or alcohol
If you had ever overdosed with an opioid or another drug
Asked of chronic opioid users
27. The first time your healthcare provider prescribed the opioid you are currently taking for long-term chronic non-cancer pain, did she/he do any of the following? (Response options: Yes, No, Not sure)
Establish an opioid contract with you
Prescribe a limited number of days and require a follow-up office appointment for reassessment
Prescribe medicines that can bring someone back from an overdose of opioids, such as Narcan, naloxone, or Evzio
Evaluate your ability to perform everyday activities
Tell you the rules the healthcare provider or practice has for patients who are prescribed opioids, like signing a contract, taking a urine drug screen test, or counting opioid pills
Asked
of chronic opioid users
28. Did your healthcare provider discuss any of the following types of treatment before prescribing the opioid you are currently taking for your long-term chronic non-cancer pain? (Response options: Yes, No, Not sure)
Over-the-counter pills for pain such as aspirin, acetaminophen (for example, Tylenol), ibuprofen (for example Advil), or naproxen (for example, Aleve)
Non-opioid prescription pain relievers such as steroids like prednisone or non-steroidal anti-inflammatory drugs (NSAIDs)
Prescription medicines for depression
Prescription medicines for seizures such as phenytoin (Dilantin) or carbamazepine (Tegretol)
Prescription medicines for nerve pain such as pregabalin (Lyrica) or gabapentin (Neurontin)
Over-the-counter pain-relief creams, ointments, gels, patches, etc., that can be purchased without a prescription such as Bengay, Icy Hot, or Aspercreme
Pain-relief devices such as stimulators or TENS (transcutaneous electrical nerve stimulation)
Prescription pain-relief creams, ointments, and gels
Water or pool therapy
Home exercises or stretches
Weight loss
Physical therapy
Treatment by a chiropractor
Relaxation training/biofeedback/mindfulness interventions
Nerve blocks or injections
Acupuncture
Herbal remedies or other alternative medicines
Medical marijuana
Therapy with a counselor
Other (write in any others your healthcare provider discussed with you that are not listed above)
Asked of chronic opioid users only
29. How well did each of the following non-opioid pain treatments work for managing your long-term chronic non-cancer pain? Select one answer in each treatment row.
Non-opioid Pain Treatment |
I have not tried it but would be willing to try it. |
I have not tried it but would NOT be willing to try it. |
I tried it, and it did not reduce my pain at all. |
I tried it, and it worked to reduce my pain some. |
I tried it, and it worked to reduce my pain a lot. |
Over-the-counter pills for pain such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) |
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Non-opioid prescription pain relievers, including anti-inflammatories such as steroids like prednisone or non-steroidal anti-inflammatory drugs (NSAIDs) |
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Prescription medicines for depression |
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Prescription medicines for seizures such phenytoin (Dilantin) or carbamazepine (Tegretol) |
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Prescription medicines for nerve pain such as pregabalin (Lyrica) or gabapentin (Neurontin) |
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Over-the-counter pain-relief creams, ointments, gels, patches, etc., that can be purchased without a prescription such as Bengay, Icy Hot, Aspercreme) |
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Pain-relief devices such as stimulators or TENS (transcutaneous electrical nerve stimulation) |
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Prescription pain-relief creams, ointments, and gels. |
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Water or pool therapy |
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Home exercises or stretches |
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Weight loss |
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Physical therapy |
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Treatment by a chiropractor |
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Relaxation
training/ |
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Nerve blocks or injections |
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Acupuncture |
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Herbal remedies or other alternative medicines |
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Medical marijuana |
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Therapy with a counselor |
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Asked of chronic opioid users
30. Since your healthcare provider first prescribed the prescription opioid medicine you are currently taking for chronic non-cancer pain, how often has he/she talked with you about each of the following? (7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
How well the opioid medicine is working to control your chronic non-cancer pain
How much your pain affects your quality of life
Your worries or concerns about taking opioids
Side affects you may be having from the medicine
Changes in your ability to do everyday activities (for example, at home and work)
How you are feeling emotionally
Your goals for opioid therapy to improve your ability to perform activities at home and work
How long he/she thinks you will need to take the medicine
A plan for reducing the amount or frequency of the opioid or getting off the medicine
Switching to another type of pain treatment
Changes in your relationships with others
Changes in your behavior
Signs and symptoms of dependency or addiction
Your concerns about possible dependence or addiction to your opioid
If you have experienced a feeling of euphoria, or being “high”
If you have taken more of the opioid or taken it more often than prescribed
Possible tolerance
Possible overdose
If you have started any new prescription medicines since your last visit such as those for pain, anxiety, depression, or sleep problems
If you have taken the opioid with alcohol, marijuana, or illegal drugs
The possibility of referring you to a pain specialist
The need for mental health/behavioral therapy (for example, to help with stress, anxiety or depression that might be adding to the pain)
Asked of chronic opioid users
31. How often does your healthcare provider do each of the following during follow-up appointments about your chronic non-cancer pain? (7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
Review your patient agreement or contract with you
Conduct or order urine drug testing
Conduct periodic unscheduled pill counts
Evaluate your ability to perform everyday activities
Asked of chronic opioid users
32. How often does this happen when you talk to your healthcare provider(s) about your worries or concerns about possible opioid addiction or misuse? (7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
I don’t know how to talk to my healthcare provider about possible addiction.
I don’t know how to talk to my healthcare provider about the fact that I am taking more of my opioid than prescribed.
I feel like my healthcare provider does not have time to listen to my concerns about possible addiction.
I worry about how my healthcare provider might react if I talk with him/her about possible addiction.
I worry about how my healthcare provider might react if I talk with him/her about taking more of my opioid than prescribed.
I worry that I will hurt my relationship with my healthcare provider if I talk with him/her about possible addiction or misuse.
I worry that my healthcare provider will blame or judge me if I talk with him/her about possible addiction.
I don’t know what my healthcare provider can do to help me with possible addiction.
I am worried that talking about any problems with taking my opioid will break my treatment agreement or contract.
I am scared that my healthcare provider will report me if I talk with him/her about possible misuse.
I worry that my healthcare provider will not treat my pain anymore if I talk with him/her about possible addiction.
I worry that my healthcare provider will not treat my pain anymore if I talk with him/her about misuse.
I don’t have any of these worries or concerns.
Asked of chronic opioid users
33. How positive or negative an effect has your use of prescription opioids had on each of the following: (Extremely positive, Moderately positive, Slightly positive, Neither negative or positive, Slightly negative, Moderately negative, Extremely negative)
Your physical health
Your mental health
Your personal relationships
Your quality of life
Your ability to do your job
Your finances
Asked of chronic opioid users
34. How effective do you think each of the following is in evaluating the level of pain that opioid patients are having? (7-point scale: Extremely ineffective; Ineffective; Somewhat ineffective; Neither ineffective, nor effective; Somewhat effective; Effective; Extremely effective)
Pain scales or ratings (for example, on a 10-point scale)
How much their pain interferes with their everyday activities
Recent and current psychological or emotional state
Changes in activities of daily living
Asked of chronic opioid users
35. To what extent have you personally experienced each of the following while taking opioids for chronic non-cancer pain? ((7-point scale: Never, Rarely, Occasionally, About half the time, Frequently, Usually, Always)
The opioid didn’t reduce your pain
Misuse (taking more of an opioid or more often than prescribed in order to treat the pain)
Abuse (taking more of an opioid in order to get high)
Tolerance
Addiction
Withdrawal
Overdose
Requested pain medicines before a refill is due
Received opioid prescriptions from other healthcare providers at the same time
Shared prescription pain medicines with family members or friends
Your prescribed opioid fell into the wrong hands (children, teens)
Your opioids were stolen
You used alcohol while you were being treated with opioids
You used recreational marijuana while you were being treated with opioids
You used illicit drugs such as heroin while you were being treated with opioids
Asked of chronic opioid users
36. How much experience do you have taking each of the following? (Response options: “No experience at all, Very little experience, A little experience, Some experience, A moderate amount of experience, A large amount of experience, A very large amount of experience)
Immediate-release/short-acting opioids such as codeine, morphine, Demerol, oxycodone (Percocet), hydrocodone (Vicodin) and hydromorphone (Dilaudid)
Extended-release/long-acting opioids (ER/LAs) such as OxyContin, fentanyl patches (Duragesic), MS Contin, OxyContin and Exalgo
Abuse-deterrent opioids
Medication-assisted treatment (MAT) therapies such as buprenorphine, methadone and naltrexone
Opioid-reversal agents such as naloxone, Narcan and Evzio
37. What is the name of the opioid medicine you are currently taking for your chronic non-cancer pain? (Write in)
38. For how long have you been taking this opioid medicine for your chronic non-cancer pain? Select one answer.
More than 3 months to 6 months
More than 6 months to 1 year
More than 1 year to 3 years
More than 3 years to 5 years
More than 5 years
| File Type | application/msword |
| Author | Agajelu, Ogochukwu * |
| Last Modified By | SYSTEM |
| File Modified | 2017-10-16 |
| File Created | 2017-10-16 |