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The Request for Opioids

Navigate a request for an early opioid refill from a patient with chronic pain who is exhibiting some red flags.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Mr. Jones in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

1. Learning: Navigating Opioid Requests

Purpose of this Scenario

This scenario addresses the complex and high-stakes conversation around opioid prescribing for chronic pain. The goal is to balance empathy for the patient's suffering with the profound responsibility of safe prescribing. This requires setting firm boundaries, de-escalating potential conflict, and focusing on a multimodal approach to pain management.

Key communication strategies include:

  • Start with Empathy: Begin by acknowledging the patient's pain. "I can hear how much pain you're in, and I want to help you manage that safely."
  • Use "I" Statements and Express Concern: Frame your refusal in terms of your concern for their safety. "I am concerned that refilling this early could be unsafe," is better than "You are asking for this too early."
  • Refer to Objective Policies: Reference clinic policies or state laws (like the prescription monitoring program) as a neutral third party. "Our clinic policy for safety is that we cannot refill these medications ahead of schedule."
  • Pivot to a Broader Plan: Shift the conversation from just the prescription to a more comprehensive pain management plan. Offer alternatives like non-opioid medications, physical therapy, or referrals to pain management specialists.

2. Scenario Briefing

Your Objective

Your objective is to have a conversation with Mr. Jones, a 58-year-old man with chronic back pain who is requesting an early refill of his oxycodone. You must decline the early refill while de-escalating his frustration and pivoting to a discussion about a safer, more comprehensive pain plan.

Patient Background

Mr. Jones is a 58-year-old man you have inherited from a retiring partner. He has a long history of chronic low back pain from a work injury and has been on a stable dose of oxycodone for several years. He is here today asking for a refill two weeks early, stating he "ran out."

Crucial Information: Before the encounter, you checked the state's prescription drug monitoring program (PDMP) and saw that he also received a prescription for oxycodone from an urgent care center two weeks ago after "losing" his bottle. This is a significant red flag.

Key Medical Facts

  • Condition: Chronic low back pain, status post lumbar fusion 10 years ago.
  • Current Medication: Oxycodone 10mg, 1 tablet every 6 hours as needed. #120 per month.
  • The Issue: He is requesting a refill 15 days early. The PDMP shows he received an overlapping prescription 14 days ago. This pattern of behavior is high-risk.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Identify behavioral and historical red flags for potential opioid misuse or diversion.
  • Apply a structured approach to assessing a patient's request for an early opioid refill, including the use of a Prescription Drug Monitoring Program (PDMP).
  • Formulate a safe and effective pain management plan that incorporates multimodal, non-opioid strategies.

A patient on long-term opioids for chronic pain requests an early refill. Which of the following is the MOST concerning red flag for potential opioid misuse?

If a patient becomes angry after you decline their request for an early opioid refill, which communication technique is most effective for de-escalation?

Before making a final decision on an early opioid refill request from a patient with concerning behaviors, what is the most critical initial action?