Guideline for Prescribing Opioids for Chronic Pain

March 2018

doctor sitting at a desk giving a patient a prescription

As the opioid overdose epidemic continues to worsen, L.A. Care is sharing some of the recommendations from the Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain.
 
The guideline and its recommendations for primary care providers was created to help improve patient care, reduce the risks from chronic use and help determine if opioid therapy is appropriate. 
 
Before initiating an opioid therapy, physicians should always evaluate the risks versus benefits for each patient. When prescribing opioids, limit the day supply and start off slow.  
 

When Prescribing:

  • Evaluate risk factors for opioid-related harms
  • Check CURES for high dosages and prescriptions from other providers
  • Perform urine drug testing to identify use of undisclosed controlled prescription drugs/substances
  • Avoid benzodiazepines with opioids
  • Arrange treatment for opioid use disorder if needed 
 

If Increasing Dosage:

  • Carefully reassess benefits and risks when considering increasing daily dosage to > 50 MED (morphine equivalent doses)
  • Avoid increasing daily dosage to > 90 MED
  • Carefully justify a decision to titrate daily dosage to > 90 MED
 

Discuss with Patients:

  • Opioids are not first-line or routine therapy for chronic pain
  • Goals for pain and function
  • Benefits and risks with therapy
  • Nonopioid therapies for pain 
 

Encourage Heathier Lifestyles to Support Pain Management:

  • Diet - eat healthier foods in smaller amounts
  • Exercise - get moving with daily activity
  • Weight loss – as appropriate
 

Additional Information for Providers:

  • Co-prescribe naloxone, the antidote to an opioid overdose
  • Gabapentin and Pregabalin have become target drugs to combine with the use of opioids for abuse
  • Be aware of the triple threat drug combination: opioids, benzodiazepines and muscle relaxants, which have a high abuse potential and a higher potential for overdose death when used in combination
  • Discuss/encourage Medication Assisted Therapy (MAT) if an opioid use disorder is detected or suspected

To view the full prescribing guideline, please visit the CDC Opioid Overdose site.