When CONSIDERING long-term opioid therapy
Set realistic goals for pain and function based on diagnosis (e.g, walk around the block).
Check that non-opioid therapies tried and optimized.
Discuss benefits and risks (eg, addiction, overdose) with patient.
Evaluate risk of harm or misuse.
• Discuss risk factors with patient.
• Check prescription drug monitoring program (PDMP) data.
• Check urine drug screen.
Set criteria for stopping or continuing opioids.
Assess baseline pain and function (eg, PEG scale).
Schedule initial reassessment within 1– 4 weeks.
Prescribe short-acting opioids using lowest dosage on product labeling; match duration to scheduled reassessment.
If RENEWING without patient visit
Check that return visit is scheduled ≤ 3 months from last visit
When REASSESSING at return visit
Continue opioids only after confirming clinically meaningful improvements in pain and function without significant risks or harm.
Assess pain and function (eg, PEG); compare results to baseline.
Evaluate risk of harm or misuse:
• Observe patient for signs of over-sedation or overdose risk.
– If yes: Taper dose.
• Check PDMP.
• Check for opioid use disorder if indicated (eg, difficulty controlling use).
– If yes: Refer for treatment.
Check that non-opioid therapies optimized.
Determine whether to continue, adjust, taper, or stop opioids.
Calculate opioid dosage morphine milligram equivalent (MME).
• If ≥ 50 MME/day total (≥50 mg hydrocodone; ≥ 33 mg oxycodone),
increase frequency of follow-up; consider offering naloxone.
• Avoid ≥ 90 MME /day total (≥ 90 mg hydrocodone; ≥ 60 mg oxycodone),or carefully justify; consider specialist referral.
Schedule reassessment at regular intervals (≤ 3 months)