OPIOID GUIDELINES

Important state and federal guidelines include: 2016 CDC guideline for Prescribing Opioids for Chronic Pain, Oregon Opioid Prescribing Guidelines, OHSU Adult Safe Opioid Prescribing Guideline for Chronic and Non–end–of–life pain. I will summarize a few key points from these guidelines: 

  1. Non–pharmacologic therapy and non–opioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and non–opioid pharmacologic therapy, as appropriate. 
  2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient and community safety. 
  3. When opioids are started, clinicians should prescribe the lowest effective dose considered. Clinicians should use 

caution when prescribing opioids at any dosage. 

  1. The effectiveness of the treatment, particularly as it relates to the patient’s functional status, should be regularly assessed, and documented. If benefits do not outweigh the risk and harms of the continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to the lower dosages or taper off and discontinue the opioids. 
  2. Urine drug testing is a tool used to assist providers in assessing whether patients are using opioids as prescribed, 

using other substances or potentially diverting opioids. 

  1. The amount of prescribed opioid should be limited. When treating chronic pain, there is rarely a reason to exceed 

50 morphine equivalent dose (MED) of opioid, and almost never a reason to exceed 90 MED. 

Multiple other opioid related policies exist that may be discussed at clinic appointments if needed.