HelixTalk Episode #61 - Correcting the course: careful opioid prescribing

Date posted: May 23, 2017, 6:00 am

In this episode, we review the 12 recommendations from the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.  These recommendations are intended to help curb the opioid epidemic and provide guidance to healthcare providers regarding safer use of opioid therapy.

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Key Concepts

1. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain is available for free at the following link: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
2. The CDC guidelines outlined twelve basic recommendations for healthcare providers regarding safer use of opioid therapy.  In summary, these recommendations include:
   • Favor non-opioid analgesic and non-pharmacologic therapies for chronic pain.
   • Before initiating opioids, discuss realistic treatment goals and the risks/benefits of opioid therapy.
   • When initiating opioids, use immediate release (IR) formulations; extended release (ER) formulations should only be used in opioid-tolerant patients.
   • When using opioids, use the lowest effective dose for the shortest period of time.  Be cautious when titrating above 50 to 80 MME (morphine milligram equivalents) per day.
   • Consider risk factors that increase the chances of harm, such as concurrent benzodiazepines, hepatic or renal impairment, advanced age, larger doses of opioids, and those with a history of substance abuse disorders.
   • Consider the use of prescription drug monitoring programs (PDMP) and regular urine drug screening to assess for polypharmacy or misuse.
   • If an opioid use disorder is identified, offer to arrange for treatment as opposed to stopping all care of the patient.