Zoom Issue Tracking

1

Do you find yourself taking more pain medication than your doctor recommended?* This field is required.

YESNO

2

Have you ever run out of your prescription early?* This field is required.

YESNO

3

Do you watch the clock until it will be time to take your pain medication?* This field is required.

YESNO

4

Do you sometimes mix the medication with alcohol or other drugs?* This field is required.

YESNO

5

Have you taken pain medication that isn’t prescribed to you?* This field is required.

YESNO

6

Are you relying on pain medication for emotional relief from loneliness, depression, anxiety, or similar?* This field is required.

YESNO

7

Have you ever put off taking your medication so you could justify taking a larger dose later?* This field is required.

YESNO

8

Have you been tempted to mislead your doctor or pharmacist to ensure you continue to receive your prescription?* This field is required.

YESNO

9

Do you find yourself obsessing about your medication (thinking about it, counting it, checking to be sure it's available)?* This field is required.

YESNO

10

Have you considered switching doctors to ensure you can receive or increase your prescription?* This field is required.

YESNO

11

Do you feel defensive or angry if someone mentions your use of pain medication?* This field is required.

YESNO

12

Do you lie to people or deflect when they ask about your medication use?* This field is required.

YESNO

13

Do you, or have you been tempted to, take your medication in a manner that it's not intended (like crushing your pills instead of swallowing them)?* This field is required.

YESNO

14

Total Score