Clinical Reminders for Prescribing Opioids

• Opioids are not first-line or routine therapy for chronic pain. Use non-pharmacologic therapy as appropriate.

• Establish and measure goals for pain and function.

• Talk with your patient about the benefits and risks of opioid therapy and availability of non-opioid therapies.

• When starting therapy, use immediate-release opioids; start low and go slow.

• When opioids are needed for acute pain, prescribe no more than needed; three days or less is often sufficient; more than seven days is rarely needed.

• Do not prescribe ER/LA opioids for acute pain.

• Follow up during opioid therapy and re-evaluate risk of harm; reduce dose or taper and discontinue if needed.

• Always check Michigan Automated Prescription System (MAPS) for high dosages and prescriptions from other providers.

• Document in the patient record your decision to prescribe (or not to prescribe) controlled substance medication if you believe it is necessary (e.g. to explain the prescription in light of a patient's high Narx score). 

• Use urine drug testing to identify prescribed substances and undisclosed use.

• Avoid concurrent benzodiazepine and opioid prescribing.

• Arrange treatment for opioid use disorder if needed.