The CDC issued 12 recommendations related to opioid prescription use.1 The following is a summary of those recommendations:
Determining when to initiate or continue opioids for chronic pain:
1. Non-drug therapy and non-opioid drug therapy are preferred for chronic pain. Clinicians should consider opioid therapy only when expected benefits are expected to outweigh risks to the patient. When opioids are prescribed, they should be combined with non-drug therapy and non-opioid drug treatments.
2. Clinicians should establish treatment goals with all patients before starting opioid therapy for chronic pain. Goals should be realistic and consider how therapy will be discontinued if benefits do not outweigh risks to patient safety. Opioid therapy should be continued only when there is meaningful improvement in pain and function and these outweigh risks.
3. Clinicians should discuss known risks and realistic benefits of opioid therapy with patients before starting and periodically during opioid therapy.
Opioid selection, dosage, duration, follow-up, and discontinuation:
4. Prescribe immediate-release opioids instead of extended-release/long-acting opioids when starting opioid therapy for chronic pain.
5. Prescribe the lowest effective dose when starting opioid therapy.
6. Prescribe the lowest effective dose of immediate release opioids and prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less often is sufficient; more than seven days is rarely necessary.
7. Evaluate benefits and harms to patients within one to four weeks of starting opioid therapy for chronic pain or dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every three months or more frequently. If harms outweigh benefits, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.
Assessing risk and addressing harms of opioid use:
8. Continually evaluate risk factors for opioid-related harms. Incorporate strategies to mitigate risk into the management plans, including offering naloxone when there are factors that increase risk for opioid overdose.
9. Review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is using opioids in dangerous doses and combinations that place the person at risk for overdose.
10. When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually.
11. Avoid prescribing opioid pain medication and benzodiazepines concurrently.
12. Offer patients with opioid use disorder evidence-based treatment, which usually is medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies.