Find resources that highlight opioid prescribing recommendations, improve the safety and effectiveness of pain treatment, and reduce the risk of overdose and opioid use disorder.
|INitial ASSESSMENT||Follow-up assessments|
Download complete CDC Checklist for Prescribing Opioids for Chronic Pain
As a healthcare provider, you have a responsibility to ensure controlled substances are prescribed solely for a genuine medical need.
While there's no uniform way to identify medication misuse, there are some common signs you may see:
- Assertive personality (e.g., demanding immediate action)
- Unusual knowledge of controlled substances
- Gives medical history with textbook answers or gives vague answers relating to their medical history
- May request a specific drug and be reluctant to try something different
- No interest in diagnosis and often fails to keep appointments for further diagnostic tests or consultation with another practitioner
- Patient may decline permission to obtain past records
- Claims to be a patient of a practitioner that is not currently available
- Has multiple unexplained dose escalation or non-adherence to treatment plans
Naloxone co-prescribing is one important tool prescribers can use to help prevent opioid overdose deaths and increase the opportunity to link overdose survivors to treatment. Co-prescribing naloxone is strongly recommended for patients at-risk for opioid overdose. In continuing these efforts, prescribers and other healthcare providers can monitor patients for risk of overdose, prescribe or dispense naloxone when overdose risk factors are present, and counsel patients on how to use it.
Naloxone is not currently available over-the-counter. However, Idaho’s law allows pharmacists and other health professionals to prescribe and dispense to anyone at risk for an opioid-related overdose or to anyone who may encounter such an individual.
Calculating the total daily dose of opioids helps identify patients who are at higher risk of overdose.
Use extra precautions for patients at ≥50 MME/day such as closer monitoring, reduction or tapering of opioids, and/or prescribing of naloxone. Avoid or carefully justify increasing dosage to ≥90 MME/day.
1. Determine the total daily amount of each opioid the patient takes
2. Convert each to MME — multiply the dose for each opioid by the conversion factor (see table)
3. Add them together
Access a free opioid dose calculator HERE
Consider tapering to a reduced opioid dosage, or tapering and discontinuing opioid therapy, when:
- Pain improves
- The patient requests dosage reduction or discontinuation
- Pain and function are not meaningfully improved
- The patient is receiving higher opioid doses without evidence of benefit from the higher dose
- The patient has current evidence of opioid misuse
- The patient experiences side effects that diminish quality of life or impair function
- The patient experiences an overdose or other serious event (e.g., hospitalization, injury) or is in a high-risk situation
- The patient is receiving medications (e.g., benzodiazepines) or has medical conditions that increase risk for adverse outcomes
For more guidance on tapering opioid prescriptions, refer to the CDC’s video: “Tapering Opioids for Chronic Pain”
The Idaho PDMP is a statewide electronic database that collects designated data on controlled substances dispensed in Idaho and is connected with prescription drug monitoring programs in neighboring states. This tool – provided to prescribers of controlled substances and pharmacists who are considering dispensing controlled substance prescriptions to patients serves several purposes:
- Supports access to legitimate medical use of controlled substances
- Identifies and deters or prevents drug abuse and diversion
- Helps identify and facilitates treatment of person with opioid use disorder (or substance use disorder)
- Avoids dangerous combinations of benzodiazepines and opioids
- Informs public health initiatives through analysis of the PDMP database
Beginning October 1, 2020, Idaho providers are required ito check the PDMP prior to issuing an opioid or benzodiazepine prescription that is for more than a 3-day supply.
Register for the Idaho PDMP: https://idaho.pmpaware.net
Already registered? Access the Idaho PDMP HERE
Earn free CE/CME
Original Release Date: September 1, 2018
Review Date: September 1, 2020
Re-release date: June 1, 2021
Expiration date: May 31, 2023
This learning activity is designed for Idaho healthcare prescribers.
Upon completion of this educational activity, participants should be able to:
- Describe the opioid epidemic in Idaho
- Integrate CDC’s Guideline for Prescribing Opioids for Chronic Pain in provider practices
- Create and interpret PDMP data reports
- Use patient prescription history to inform clinical decision-making
- Identify the warning signs of medication misuse in patients
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Federation of State Medical Boards, the Idaho State Board of Medicine and the Idaho Department of Health and Welfare. The Federation of State Medical Boards is accredited by the ACCME to provide continuing medical education for physicians.
The Federation of State Medical Boards designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Federation of State Medical Boards certifies that non-physicians will receive a participation certificate stating that they participated in the enduring material that was designated for 1.0 AMA PRA Category 1 Credit™.
Course director and presenter
Magni Hamso, MD, MPH
Medical Director, Idaho Department of Health and Welfare, Division of Medicaid
Staff Physician, Boise VA Medical Center
Dr. Hamso is the medical director for Idaho Department of Health and Welfare’s Division of Medicaid. She is a clinical assistant professor at the University of Washington and a part-time staff physician at the Boise VA, where she cares for veterans with chronic pain and opioid use disorder and teaches students and residents. She is board-certified in internal medicine and addiction medicine. She attended college at Yale University and medical and public health school at Columbia University. She completed her residency and chief residency at Montefiore/Einstein’s Primary Care and Social Internal Medicine Residency Program in the Bronx, New York.
This learning activity is not funded by any commercial entity.
Disclosure of commercial interest
As an organization accredited by the ACCME, the Federation of State Medical Boards (FSMB) requires that the content of CME activities and related materials provide balance, independence, objectivity, and scientific rigor. Planning must be free of the influence or control of a commercial entity and promote improvements or quality in healthcare. Anyone in the position to control the content of an education activity are required to disclose all relevant financial relationships in any amount occurring within the past 12 months with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.
The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The FSMB has implemented a mechanism to identify and resolve all conflicts of interest before the activity. The intent of this policy is to identify potential conflicts of interest so participants can form their own judgments with full disclosure of the facts. Participants will be asked to evaluate whether the speaker’s outside interests reflect a possible bias in the planning or presentation of the activity.
The speaker, course director, and planners at the Federation of State Medical Boards, the Idaho State Board of Medicine, and the Idaho Department of Health and Welfare have no relevant financial interests to disclose.
Disclosure of unlabeled uses
This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the U.S. Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, refer to the prescribing information for each product, or consult the "Physicians’ Desk Reference."
Faculty and staff disclosures
No speakers or people in control of content reported intent to reference unlabeled/unapproved uses of drugs or products.