The United States is in the midst of an opioid crisis. In fact, the U.S. Department of Health and Human Services reports that more than 2 million Americans abuse opioids and that more than 130 overdose-related deaths occur each day. This crisis puts doctors in a very difficult situation when it comes to treating patients with chronic pain. When is prescribing opioids for chronic pain appropriate? What are the risks of doing so? Below, we’ll outline some tips for doctors who may be dealing with this dilemma!
Prescribing Opioids for Chronic Pain
When to Prescribe Opioids for Pain
It’s essential for physicians and their patients to remember that opioids are not a first choice or routine method for treating chronic pain. There are other methods for treating chronic pain, like nonpharmacologic therapy or nonopioid pharmacologic therapy, which you should try first. Physicians should only consider opioid therapy if previous methods for pain treatment are not effective. It’s the physician’s job to determine whether or not the benefits of opioid therapy will outweigh the risks to the patient. Keep in mind that opioid therapy should be combined with other types of pain management, as appropriate.
Before starting opioid therapy, it’s essential for physicians to establish treatment goals with their patients. Physicians should set realistic goals for pain and function for all of their patients. They should also discuss the risks and benefits of opioid therapy with their patients. Reminding patients that they will discontinue the prescription should the benefits not outweigh the risks is also very important.
Opioid Selection, Dosage, and Duration
Once a clinician decided that prescribing opioids for chronic pain is the best course of action, it’s time for them to select an opioid and a dosage. When starting opioid therapy, the CDC advises physicians to prescribe immediate-release opioids as opposed to extended-release or long-acting opioids. Once the patient starts opioid therapy, clinicians should prescribe the lowest effective dose. Throughout the whole process, physicians should regularly discuss the benefits and risks of opioid therapy with their patients. The CDC also notes that “clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain.” Prescribing opioids for chronic pain is a serious decision that should not be taken lightly. Below, we’ll discuss the risks of opioid use.
Assessing the Risks of Opioid Use
Before prescribing opioids to a patient, physicians should carefully consider a patient’s risk for overdose. For example, if the patient has a history of overdoses or substance use disorder, this is a red flag for doctors. Consider alternative methods for treating pain if this is the case.
Next, the CDC recommends that physicians should review the patient’s history of controlled substance prescriptions to determine whether the patient is potentially at risk for overdose. Additionally, physicians should use urine drug testing before starting opioid therapy. That way, they can screen a patient for other prescribed medications, controlled substances, or illicit drugs. This will allow doctors to identify potentially dangerous drug combinations.
Three Major Takeaways
While there are dozens of recommendations and strategies for prescribing opioids for chronic pain, the CDC outlines three principles that are vital:
- Aside from active cancer and palliative or end-of-life care, nonopioid therapy is widely preferred for chronic pain.
- When prescribing opioids, physicians should administer the lowest effective dosage. This will help to reduce the risks of opioid use disorder and overdose.
- Providers should always exercise caution when prescribing opioids for chronic pain and monitor all patients closely and regularly.
What are your thoughts on the opioid epidemic in the United States? Do you think physicians should be able to continue prescribing opioids for chronic pain? Share your thoughts in the comments below! We would love to hear from you.