Why do we focus on opioid prescribing?
Higher doses of opioids increase the risk of overdose and death. Serious consequences of long-term opioid use include death, accidents, and increasing disability. The Centers for Disease Control and Prevention described prescription pain medication overdose as a growing and deadly epidemic.
Long-term effectiveness of opioids is unclear. Pain perception can be altered by opioids, resulting in hyperalgesia. As a result, many patients report reduced pain when their opioids are discontinued.
What are the Key First Steps for Patients Taking Prescription Opioids?
As prescribers, we have a major role to play in reducing Utah's opioid epidemic. For patients taking opioids, monitoring is critical for opioid use disorder, unhealthy use, or diversion (e.g., bypassing MMA agreements, going to the ED to get medications, going to another office to get more medications, etc.). In these situations, consider discussing your concerns with the patient and recommend a tapering approach. If the patient resists recommendations, respectfully "agree to disagree" with the patient's perspective and encourage compliance with recommendations.
What is Recommended for High-risk Situations?
For opioid use disorder or dangerous aberrant behaviors, tapering is likely not the best approach. For diversion, contact your facility's risk management or legal department. In any of these situations, consider:
- Medication-assisted treatment, such as buprenorphine
- Consultation with an addiction specialist
- Admission for detoxification / discontinuation rather than tapering
- Performing or requesting a mental health assessment
Access the Opioid Prescribing Key Strategies: Quick Reference Guide for key strategies related to addiction/overdose prevention and treatment considerations when prescribing, managing/tapering, and coordinating care.