WHEN YOU DECIDE TO PRESCRIBE OPIOIDS
1 ACUTE PAIN THERAPY
Long-term opioid use often begins with treatment of acute pain. So, when opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids for the shortest therapeutic duration. Three days or less will often be sufficient; more than seven days will rarely be needed.
2 LONG-TERM THERAPY CONSIDERATIONS
Experts agreed that before opioid therapy is initiated for chronic pain outside of active cancer, palliative, and end-of-life care, prescribers should determine how effectiveness will be evaluated and should establish treatment goals with patients. Because the line between acute pain and initial chronic pain is not always clear, it might be difficult for prescribers to determine when they are initiating opioids for chronic pain rather than treating acute pain. Pain lasting longer than 3 months or past the time of normal tissue healing (which could be substantially shorter than 3 months, depending on the condition) is generally no longer considered acute.
3 OPIOID DOSING
Higher dosages of opioids are associated with higher risk of overdose and death, but higher dosages have not been shown to reduce pain over the long term. Extra precautions should be used when increasing to ≥ 50 morphine milligram equivalents (MME) per day and avoid or carefully justify increasing dosage ≥ 90 MME/day. There are a number of online MME calculators to help calculate the total dosage of opioids. Because of an increased risk of fatal overdose, prescribers should avoid the combination of prescription opioids and benzodiazepines when possible. State Prescription Drug Monitoring Programs (PDMPs) can inform clinicians about the types and dosages of controlled substances a patient has received from other prescribers, which can be used to help determine the most appropriate opioid dose for their patient.