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 prior to writing each opioid prescription and use it as a tool to assist with clinical decision-making.
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 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.
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.
Advocate for the patient’s safety and assist patients with ongoing coordination of care for substance abuse disorders.
Perform urine drug testing before initial opioid prescriptions and on an annual basis thereafter.
Assess for presence of opioid use disorder using DSM-5 criteria or have a substance use disorder treatment specialist assess the patient.
Consider input from pharmacists and pain specialists when opioids and benzodiazepines are co-prescribed.
To reduce the risk of prescription drug fraud and improve the quality of patient care, consider using electronic prescribing for opioids.
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 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.
Keep prescription pads in a locked device that only the providers have access to.
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.
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.