Opioid Prescribing Guidelines

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Opioid prescribing guidelines help doctors manage a patient's chronic non-cancer pain consistently, safely, and effectvely. Given the epidemic of opioid over-prescribing, they help reduce the risk of opioid misuse and diversion for non-medical use, while helping people with a legitimate need for long-term pain control. A doctor can select from many guidelines from various sources.

American Society for Interventional Pain Physician Guidelines

The American Society for Interventional Pain Physician (ASIPP) opioid prescribing guidelines for treatment of chronic non-cancer pain for more than 90 days represents a typical, comprehensive guide. These voluntary guidelines are frequently revised by pain experts and are based on review of current medical evidence. To help doctors decide whether and how to initiate opioid therapy for a patient with chronic pain, important elements of the guidelines include:

Doctor listening to patient's chest; © Wavebreakmedia Ltd | Dreamstime.com
  • Establish a physical and psychological diagnosis by:
    • Taking a comprehensive patient medical, psychosocial, and psychiatric history, including history of use or abuse of opioids or other drugs or risk for abuse
    • Doing a complete physical exam and ordering relevant diagnostic tests
    • Consulting a pain specialist to help guage the level of a patient's pain and opioid requirements, if needed
  • Establish the necessity and appropriateness of treatment and create a treatment plan after the evaluation is complete, which can include a signed patient agreement to reduce the risk of abuse

  • Patient education about the risks of opioids and a signed informed consent

  • Consider the goals of opioid treatment before initiating therapy and continue it only if the patient shows improvement in pain and function, with few adverse effects.

  • Start with a low-dose, short-acting opioid. Use high doses of long-acting opioids only when necessary for severe, unrelenting pain when other drugs fail to manage the pain

  • Make a plan to document and monitor opioid use from the start and during treatment by using:

    • A prescription drug monitoring program (PDMD), currently in use by 36 states, according to the CDC, which are state-based electronic databases that can track opioid use, patients at risk for abuse, and doctors who over-prescribe opioids
    • Urine drug testing to monitor drug use, if needed, to decrease the risk of opioid abuse for patients at risk
  • Establish coordination of the patient's care by a "home" physician

The guidelines are not meant to be a directive but to guide a doctor's safe prescribing in a challenging, evolving area of healthcare.

Other Guidelines

For treatment of chronic, non-cancer pain, doctors can also use one of several other opioid prescribing guidelines developed by other professional pain, general, and specialty medical societies, state medical boards and state health departments, and federal agencies. The following selections all have some basic elements in common.

American Pain Society and American Academy of Pain Medicine

Clinical Guidelines for the Use of Chronic Opioids in Noncancer Pain, developed jointly by experts from the American Pain Society and the American Academy of Pain Medicine, is a doctor's guide for patient assessment, starting, continuing, and discontinuing opioids, and how to reduce risks and adverse outcomes.

The Federation of State Medical Boards Guidlines

The Federation of State Medical Board's book, Responsible Opioid Prescribing: A Clinician's Guide, written by a pain specialist, includes model opioid prescribing guidelines, federal drug labeling regulations, and strategies for preventing opioid abuse, addiction, and diversion.

State Medical Boards and State Regulations and Guidelines

Pain Management and Opioid Prescribing Policies by State contains an alphabetical listing of state medical boards' regulations for opioid prescribing. Some state medical boards have opioid prescibing guidelines in addition to their regulations, and some states have additional guidelines from their state health departments.

State medical board regulations are enforceable by law, but guidelines are not mandatory. Visit a state medical board's website from the FSMB directory and search for a link to read their opioid prescribing regulations and guidelines.

Centers for Disease Control Guidelines

The United States Centers for Disease Control (CDC) is a federal agency with responsibility for the United States' public health. The CDC's Common Elements in Guidelines for Prescribing Opioids for Chronic Pain is a summary of the common themes from the guidelines of three U. S. states, three medical societies, the Veteran's Administration, and Canada. From this, the CDC constructed their own recommendations.

Federal Regulations

The U. S. Food and Drug Administration's Opioid Presscribing Practices and Pain Management: Role of the FDA outlines the federal agency's role in guiding the safe prescribing of opiods in the management of pain.

Evidence-based Guidelines

Opioid prescribing guidelines are based on current best medical evidence. They make it easier for doctors to organize and coordinate a treatment plan for a patient's chronic pain that will be safe and effective and help reduce the current epidemic of opiod abuse.

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Opioid Prescribing Guidelines