Had trouble thinking clearly or had memory problems?

Heard people complain that you are not completing necessary tasks? (i.e., doing things that need to be done, such as going to class, work or appointments)

Had to go to someone other than your prescribing physician to get sufficient pain relief from medications? (i.e., another doctor, the Emergency Room, friends, street sources)

Taken your medications differently from how they are prescribed?

Seriously thought about hurting yourself?

How much time have you spent thinking about opioid medications (having enough, taking them, dosing schedule, etc.)?

Been in an argument?

Had trouble controlling your anger (e.g., road rage, screaming, etc.)?

How often have you needed to take pain medications belonging to someone else?

How often have you been worried about how you’re handling your medications?

How often have others been worried about how you’re handling your medications?

Had to make an emergency phone call or show up at the clinic without an appointment?

Gotten angry with people?

Had to take more of your medication than prescribed?

Have you borrowed pain medication from someone else?

Have you used your pain medicine for symptoms other than for pain (e.g., to help you sleep, improve your mood, or relieve stress)?

Have you had to visit the Emergency Room?