BEST PRACTICES

These best practice recommendations are based on the CDC's opioid prescribing guidelines for chronic pain outside of active cancer, palliative and end-of-life care. They are best used when considering transitioning a patient from acute pain management to chronic pain management.

CHECK K-TRACS

Check K-TRACS prior to writing each opioid prescription and use it as a tool to assist with clinical decision-making.

START WITH ALTERNATIVES

Opioid therapy should not be the first line of treatment. Instead, choose a combination of non-opioid pharmacological therapy and non-pharmacological therapy to maintain patient safety.

CONSIDER HEALTH HISTORY

Consider a patient’s medical and mental health history before prescribing opioids because the drugs can increase the risk for opioid use disorder (OUD), overdose, heart attack and motor vehicle injury.

USE THE LOWEST DOSE

Take a proactive approach to promoting patient safety by prescribing the lowest dose of immediate-release opioids rather than high doses or extended-release/long-acting opioids (ER/LA), such as methadone, transdermal fentanyl, hydrocodone, morphine, etc.

COORDINATE CARE

Advocate for the patient’s safety and assist patients with ongoing coordination of care for substance abuse disorders.

USE URINE DRUG TESTING

Perform urine drug testing before initial opioid prescriptions and on an annual basis thereafter.

ASSESS FOR SUDs

Assess for presence of opioid use disorder using DSM-5 criteria or have a substance use disorder treatment specialist assess the patient.

CONSULT WITH OTHER CLINICIANS

Consider input from pharmacists and pain specialists when opioids and benzodiazepines are co-prescribed.

USE ELECTRONIC PRESCRIBING

To reduce the risk of prescription drug fraud and improve the quality of patient care, consider using electronic prescribing for opioids.

SEEK EXPERT ADVICE FOR METHADONE

Providers who are familiar with the methadone “unique risk profile” are the most qualified to administer this medication as they must consider EKG monitoring, risk assessment for QT prolongation, and education before methadone is prescribed for pain.

RE-ASSESS MORE OFTEN

Re-assess patients more frequently than once every 3 months to take proactive steps, re-evaluate the care plan and stay on track with current treatment goals. Referrals to a pain and/or behavioral health specialist may be required when factors that increase risk for harm are present.

LOCK UP PRESCRIPTION PADS

Keep prescription pads in a locked device that only the providers have access to.

SPECIAL CONSIDERATIONS FOR PRESCRIBING

RURAL POPULATIONS

The CDC reports that primary care providers in rural counties have a higher percentage of patients prescribed an opioid compared to urban counties, and drug poisoning death rates were higher in rural counties for commonly prescribed, natural and semi-synthetic opioids and psychostimulants.

SEX & GENDER DIFFERENCES

Studies show women perceive pain differently than men, women are more likely to have conditions that lead to chronic pain, and opioid receptors respond differently to prescription opioids based on gender.