The Six Building Blocks © were developed as part of a research project on Team Based Opioid Management. The three-year research study is a collaboration of 20 rural clinics in Washington and Idaho. Funding is provided by the U.S. DHHS AHRQ grant # R18HS023750. For further information, contact Dr. Michael Parchman, Director, MacColl Center for Innovation, Kaiser Permanente Washington Health Research Institute.

The Six Building Blocks have been adapted for the Oregon Health Authority Prescription Drug Overdose (PDO) project and aligned with the CDC Guidelines for Prescribing Opioids for Chronic Pain. For information about the PDO project, contact Lisa Shields, PDO project manager, at

NOTE – If your clinic or health system is interested in participating in the Six Building Blocks project, contact Nadejda Razi-Robertson at

1. LeadershipClinic leadership sets the goals for treatment of pain, both acute and chronic, and the safe use of opioids where appropriate 2. PoliciesThe clinic's goals are supported by corresponding policies. Conversations with the patient explain how these policies ensure their safety and promote improved quality of life. The treatment agreement is a key part of patient education. 3. Tracking Patients on OpioidsThe patient population includes all patients receiving opioids. Each clinic will determine the most efficient way to identify and track this population given the tools and staff skills available. 4. Patient-Centered VisitsBefore routine clinic visits by patients with persistent pain, the patient history, current care plan, and future treatment options are discussed before the visit. If behavioral health (or PT, etc.) may be needed, a list of local or regional resources is available. 5. Caring for Complex PatientsDevelop policies, screening tools, and resources to identify patients who are high risk, complex pain patients. This includes determining opioid dependence, addiction, substance use disorder. Referral may be necessary to outside specialists. 6. Measuring SuccessThe goals and clinical measures are monitored and reported at monthly meetings with the leadership and other providers. The leadership discusses the results with the clinical team and encourages suggestions for improvement.