Long-term opioid use often begins with treatment of acute pain. CDC’s Guideline for Prescribing Opioids for Chronic Pain is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care, but is a critical component of ending opioid abuse and addiction on our country.
A brief summary is provided below. View complete recommendations on the CDC web site.
- Consider alternatives to opioids and offer opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks. Continue ongoing opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
- Before starting and periodically during opioid therapy, discuss with patients known risks and realistic benefits of opioid therapy and patient responsibilities for managing therapy.
- When opioids are used for acute pain, prescribe the lowest effective dose of immediate-release opioids and lowest effective quantity. Three days or less will often be sufficient; more than seven days will rarely be needed.
- Evaluate patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation and every 3 months or more frequently if opioids are continued. Based on risks, optimize other therapies and work with patients to taper opioids to lower dosages or to discontinue opioids.
- Incorporate strategies for each patient to mitigate risk. Consider offering naloxone. Lay person training is available for your patients at OORescue.com.
- Review PDMP data when starting opioid therapy for chronic pain and periodically thereafter, ranging from every prescription to every 3 months.
- Use urine drug testing before starting opioid therapy and consider urine drug testing at least annually.
- Avoid concurrent benzodiazepine and opioid prescribing.
- Arrange treatment for opioid use if needed.