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    Don’t lecture physicians on ‘cautious prescribing’ of opioids


    That said, the Center for Disease Control and Prevention (CDC) published new guidelines for prescribing narcotics with 12 key points. I have abbreviated them here for a quick review.

    1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are recommended as first line treatment for chronic pain which is pain present for longer than three months.
    2. Before moving to opioids, clear treatment goals should be established with the patient including when to stop the opioids if there is no improvement.
    3. The risks and benefits of opioid use should be discussed with patients.
    4. When starting therapy, use immediate-release preparations first, not long-, and start with the lowest effective dose.
    5. If treating acute pain, rarely is more than seven days of therapy needed.
    6. With chronic pain, reevaluate the situation within four weeks of start of therapy or increase in dose.
    7. Always assess risk vs. benefit every three months in chronic opioid use.
    8. Providers should have a strategy to decrease risk from opioid use in all patients including considering naloxone if risk of overdose is present.
    9. Clinicians should also check the state prescription drug monitoring program before prescribing opioids.
    10. Also, urine drug testing before start of therapy and at least annually is recommended to look for the prescribed meds in the urine and to screen for other controlled and recreational drugs.
    11. Try not to prescribe opioids with benzodiazepines if at all possible.
    12. Offer evidence-based treatment for patients who are abusing opioids. (i.e. methadone, suboxone)

    Of course, these are important guidelines to follow, but I have to think that most providers find these guidelines to be common sense. Knowing what is happening in our communities with the devastation of families and the loss of young lives is changing the way all prescribers treat opioids.

    The crisis is front and center in our practices and hopefully all providers are doing their best to help by cautious prescribing.


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    • [email protected]
      You're right Lori, that sentence is preposterous. Here's another sentence that is just as preposterous: "The best for everyone regarding opioids is very close monitoring of prescriptions and limited amounts dispensed." Of course, that preposterous line was written by you, Lori. That indicates that you are part of the problem with healthcare these days.

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