A 52-year-old man presents to the Emergency Department with a history of back, neck, and...

Given the request for opioids and history of non-prescribed opioid use (oxycodone obtained from a friend), the next appropriate step is to conduct a urine drug screen. This helps assess current substance use and guides safe prescribing decisions.

Toronto Notes 2023 – Pain Management and Addiction Medicine:

“Urine drug screening is recommended before initiating opioid therapy or when there is suspicion of substance misuse. A history of using non-prescribed opioids mandates assessment for opioid use disorder and further risk stratification.”

MCCQE1 Objectives – Internal Medicine > Chronic Pain:

“Candidates must assess for opioid misuse and dependence before initiating opioid therapy. Urine drug testing is a standard tool in this assessment.”

Providing naloxone (A) may be appropriate later if opioids are prescribed, but the priority is evaluation. Cannabis (B) is not first-line and lacks controlled evidence in chronic pain. Tramadol (D) is an opioid-like agent and not appropriate until misuse risk is evaluated.