Some states and the Centers for Disease Control and Prevention (CDC) offer opioid prescribing guidelines for doctors to follow. There are some opioid prescribing guidelines doctors have to follow, while others are advisory.
Opioid Prescribing Rules Vary by State
Some state laws attempt to curb opioid addiction by imposing limits on the supply that practitioners can prescribe. For example, in Florida, HB 21 became law in 2018. It limits the supply of opioids for acute pain to three days, though there are exceptions.
Similarly, Massachusetts law attempts to limit practitioners to prescribing no more than a seven-day supply of opioids when prescribing opioids to a patient for the first time. There are exceptions to that law as well.
Further, many states have prescription monitoring programs that attempt to track prescriptions so doctors can check what other practitioners have prescribed to a given patient.
CDC Guidelines for Opioid Prescriptions
The CDC has issued guidelines to help practitioners make safe choices when prescribing opioids. A summary of the CDC guidelines is below, though the CDC specifically states that the guidelines are not for patients undergoing cancer treatment, palliative care, or end-of-life care.
Nonopioid Pharmacologic Therapy Preferred
There is a preference for nonpharmacologic and nonopioid pharmacologic therapy. Practitioners should weigh the risks vs. benefits of prescribing opioids.
Establish Treatment Goals
Prior to starting opioid therapy for chronic pain, practitioners should establish treatment goals with the patient. Goals may relate to improvements in pain and function. Practitioners should continue opioid treatment only if the patient displays improvement in pain and function that outweighopioids’ risks to the patient’s safety.
Discuss Risks and Benefits with Patient
Practitioners should discuss the known risks and realistic benefits of opioids with the patient prior to starting therapy and periodically during therapy.
Prescribe Immediate Release Opioids When Starting Therapy
Practitioners should prescribe immediate-release (not extended release or long-acting) opioids when starting opioid therapy for chronic pain.
Prescribe Lowest Effective Dosage
When starting opioid therapy, practitioners should prescribe the lowest effective dosage, and they should reassess the benefits and risks of opioids when considering increasing the patient’s dosage.
Prescribe Lowest Effective Doseand Quantity for Acute Pain Patients
When starting opioids for acute pain, practitioners should begin with the lowest effective dose of immediate-release opioids and prescribe no more than the quantity needed for expected duration of pain. In most cases, three days or fewer will be enough.
Evaluate Benefits and Harms Within One to Four Weeks
Practitioners should review the benefits and harms of opioid therapy with the patient within one to four weeks of beginning therapy for chronic pain or after increasing the dosage.
Evaluate Risk Factors Before and During Therapy
Prior to starting and periodically during opioid therapy, practitioners should evaluate the patient’s risk factors for opioid-related harm. The management plan should include strategies to reduce risk.
Review Patient History of Controlled Substance Prescriptions
Practitioners should use the state’s prescription drug monitoring program to review the patient’s history of controlled substance prescriptions. Practitioners should check if the patient is receiving opioid prescriptions or other drugs that increase the risk of overdose. They should review the data before starting therapy for chronic pain and periodically during therapy.
Use Urine Drug Testing
Prior to starting opioid therapy for chronic pain, practitioners should use urine drug testing to assess for any prescribed medications and other controlled substances, including prescriptions and illicit drugs. Periodic urine drug testing should be done at least annually after starting therapy.
Avoid Prescribing Opioids withBenzodiazepines
Practitioners should not prescribe opioid medication with benzodiazepines whenever such a combination is avoidable.
Offer or Arrange Evidence-Based Treatment
If a patient has opioid use disorder, practitioners should offer or arrange evidence-based treatment. This usually consists of medication-assisted treatment with buprenorphine or methadone along with behavioral therapies.
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