|When considering long-term opioid therapy at Pain Clinic|
| Set realistic goals for pain and function based on diagnosis (eg, walk around the block). |
Check that non-opioid therapies are tried and optimized.
Discuss benefits and risks (eg, addiction, overdose) with the patient.
Evaluate the risk of harm or misuse.
Discuss risk factors with the patient.
Check PDMP data.
Check urine drug screen.
Set criteria for stopping or continuing opioids.
Assess baseline pain and function (eg, PEG scale).
Schedule initial reassessment within 1 to 4 weeks.
Prescribe short-acting opioids using the lowest dosage on product labeling;
match duration to scheduled reassessment.
|If renewing without a patient visit|
|Check that return visit is scheduled ≤3 months from the last visit.|
|When reassessing at a return visit|
|Continue opioids only after confirming clinically meaningful improvements in pain and function without significant risks or harm.|
| Assess pain and function (eg, PEG); compare results to baseline. |
Evaluate the risk of harm or misuse:
Observe the patient for signs of over-sedation or overdose risk.
If yes: Taper dose. Check PDMP.
Check for opioid use disorder is indicated (eg, difficulty controlling use).
If yes: Refer for treatment.
Check that non-opioid therapies are optimized.
Determine whether to continue, adjust, taper, or stop opioids.
Calculate opioid dosage MME.
If ≥50 MME/day total (≥50 mg hydrocodone; ≥33 mg oxycodone), increase frequency of follow-up; consider offering naloxone.
Avoid ≥90 MME/day total (≥90 mg hydrocodone; ≥60 mg oxycodone), or carefully justify; consider specialist referral.
Schedule reassessment at regular intervals (≤3 months).