End the Epidemic

Clinical Reminders for Prescribing Opioids for Chronic Pain

1. Opioids are not first-line or routine therapy for chronic pain. Use non-pharmacologic therapy as appropriate.
2. Establish and measure goals for pain and function.
3. Talk with your patient about the benefits and risks of opioid therapy and availability of non-opioid therapies.
4. When starting therapy, use immediate-release opioids; start low and go slow.
5. When opioids are needed for acute pain, prescribe no more than needed; three days or less is often sufficient; more than seven days is rarely needed.
6. Do not prescribe ER/LA opioids for acute pain.
7. Follow up during opioid therapy and re-evaluate risk of harm; reduce dose or taper and discontinue if needed.
8. Always check Michigan Automated Prescription System (MAPS) for high dosages and prescriptions from other providers.
9. Document in the patient record your decision to prescribe (or not to prescribe) controlled substance medication if you believe it is necessary (e.g. to explain the prescription in light of a patient's high Narx score). 
10. Use urine drug testing to identify prescribed substances and undisclosed use.
11. Avoid concurrent benzodiazepine and opioid prescribing.
12. Arrange treatment for opioid use disorder if needed.

Why It Matters 

Every day, more than 40 people in the United States die of a prescription opioid overdose.

Messages for Your Patients

• Opioids can reduce pain during short-term use, but there is no evidence that opioids control chronic pain long-term.
• Exercise, non-opioid medications, and other therapies are typically more effective with less harm.
• Regular follow up visits are important during opioid therapy.
• Precautions include checking drug monitoring databases, urine drug testing, and prescribing naloxone if needed to prevent fatal overdose.
• Protect family and friends by storing medications in their original containers and securing in a locked place out of reach of children and pets.
• Safely dispose of unused medications at a local drug take back site or, as a last resort, mix with dirt, kitty litter, or coffee grounds in a sealed container and dispose of in the trash.