Opioid prescribing: best practices

Opioids are a class of medications commonly used to manage pain. However, over the years, opioid use has become increasingly problematic, leading to an epidemic of opioid abuse and overdose deaths. As such, it is crucial to prescribing opioids appropriately and responsibly. In this blog, we will discuss best practices for opioid prescribing. 

• Evaluate the Patient’s Pain and Medical History 

As per the Centers for Disease Control and Prevention, the first step in opioid prescribing is to evaluate the patient’s pain and medical history. This assessment should include a thorough physical examination and a review of the patient’s medical records. The goal is to identify any underlying medical conditions or risk factors that may increase the patient’s susceptibility to adverse effects of opioids. 

• Start with Non-Opioid Treatments 

Opioids should only be used when other treatments have failed to alleviate pain adequately. Therefore, healthcare providers should start with non-opioid treatments such as physical therapy, acupuncture, or nonsteroidal anti-inflammatory drugs (NSAIDs). This approach helps reduce the risk of opioid dependence, overdose, and abuse. 

• Use the Lowest Effective Dose 

Opioids should be prescribed at the lowest effective dose possible to minimize the risk of adverse effects, including addiction, respiratory depression, and overdose. Prescribing high doses of opioids can also lead to tolerance, where the patient requires increasing amounts of the drug to achieve the same level of pain relief. 

• Use Short-Acting Formulations 

Short-acting opioid formulations, such as immediate-release opioids, should be used over long-acting formulations to minimize the risk of overdose and abuse. Short-acting opioids are also easier to adjust, allowing healthcare providers to tailor the dosage to the patient’s needs. 

• Limit the Duration of Opioid Therapy 

According to The New England Journal of Medicine, opioids should be prescribed for the shortest duration possible to minimize the risk of addiction and overdose. The Centers for Disease Control and Prevention (CDC) recommends that opioids be prescribed for no longer than three to seven days for acute pain and no more than seven days for postsurgical pain. 

• Educate Patients about the Risks of Opioid Use 

Patients should be educated about the risks associated with opioid use, including addiction, overdose, and respiratory depression. Healthcare providers should explain the proper use of opioids, including the importance of taking the medication as prescribed and not sharing it with others. 

• Screen for Risk Factors 

Before prescribing opioids, healthcare providers should screen patients for risk factors, including a personal or family history of substance abuse, mental health disorders, and respiratory disease. Patients with a history of substance abuse or dependence are at a higher risk of developing opioid addiction and should be closely monitored. 

• Use Prescription Drug Monitoring Programs (PDMPs) 

PDMPs are electronic databases that track the prescribing and dispensing of controlled substances, including opioids. Healthcare providers should use PDMPs to identify patients who may be at risk of opioid abuse or diversion. 

• Consider Alternative Treatments for Opioid Use Disorder 

Patients who develop opioid use disorder should be offered alternative treatments, including medication-assisted treatment (MAT) and behavioral therapy. MAT involves the use of medications such as buprenorphine and methadone to manage opioid withdrawal symptoms and cravings, while behavioral therapy helps patients develop coping skills and address underlying issues that may contribute to addiction. 

• Follow Up with Patients 

Patients taking opioids should be regularly monitored to ensure they are taking the medication as prescribed and are not experiencing any adverse effects. Follow-up visits should include a review of the patient’s pain level, medication use, and any new medical conditions or medications. 

In conclusion, opioid prescribing is a complex process that requires careful evaluation, monitoring, and management by following best practices such as evaluating the patient’s pain and medical history, starting with non-opioid treatments, and using the lowest effective dose.