However, if patients have risk factors, they should be referred to a pain management specialist, or the physician should take special precautions to deter misuse, diversion, and abuse; these measures can include prescribing only small amounts (requiring frequent visits for refills), not refilling prescriptions allegedly lost, and using urine drug screening before first prescribing opioids and periodically (eg, at least yearly) thereafter to confirm that the prescribed opioid is being taken and not diverted to others.