Research suggests that as many as 1 in 4 people receiving prescription opioids long-term struggle with addiction. Providers are in a difficult position of ensuring that patients receive appropriate treatment for pain while also mitigating risks of misuse or abuse.
Balancing under treatment versus over-prescribing for pain management can be challenging. The following 10 prescribing tips can help avoid overuse with your patients:
- Explain that opioids will be used for a limited time only. Set expectations that opioid treatment will be discontinued.
- Limit initial prescription quantities for acute pain. Prescribing a 30-day supply is often excessive, as most patients will only require only a few days of treatment. This also helps to decrease the risk of diversion if unused opioids are left lying around.
- Don’t prescribe extended-release opioids for acute pain or to opioid naïve patients.
- Don’t start the use of long-term opioids for acute pain. The routine authorization of refills could cause patients to expect the opioid treatment to continue indefinitely.
- Don’t prescribe opioids for first-line treatment of chronic pain. Non-opioid therapy is preferred pain management outside of active cancer, palliative, and end-of-life care. Consider safer alternatives such as cognitive-behavioral therapy, exercise, physical therapy, and non-opioid analgesics.
- Establish clear goals for pain management with your patients. Consider how opioid therapy will be discontinued if benefits do not outweigh risks or if there isn’t a meaningful improvement in pain.
- Start patients on the lowest effective dose of immediate-release opioids and carefully reassess benefits and risks when considering increasing dosages or switching to an extended-release product.
- Don’t assume patients know how to use opioids safely or as you intend. Take time to discuss the proper usage of opioids and the risks of misuse. For example, ensure patients know not to take extended-release medications “as-needed” for pain as well as not to vary their doses or use in combination with other CNS depressants such as alcohol.
- Don’t start a treatment you are not prepared to stop. Don’t initiate chronic opioid management without benchmarks for stopping, a procedure for tapering that you are able to use, and an approach to managing physical and psychological withdrawal symptoms.
- Check drug monitoring databases prior to prescribing opioids to minimize risks of abuse or misuse. (The Kentucky All Schedule Prescription Reporting System, which tracks controlled substances dispensed within the state, is available at https://ekasper.chfs.ky.gov/)