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 into 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 Prescription Drug Monitoring Program (PDMP) is a statewide electronic database that collects designated data on controlled substances dispensed in the state of 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:
- Support access to legitimate medical use of controlled substances.
- Identify and deter or prevent drug abuse and diversion.
- Help identify and facilitate treatment of person with opioid use disorder (or substance use
- Avoid dangerous combinations of benzodiazepines and opioids.
- Inform public health initiatives through analysis of the PDMP database.
Beginning October 1, 2020, providers are required in the state of Idaho to 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