| For primary care providers treating adults (18+) with chronic pain ≥3 months, excluding cancer, palliative, and end-of-life care. |
| When considering long-term opioid therapy |
- Set realistic goals for pain and function based on diagnosis (eg, walk around the block).
- Check that non-opioid therapies tried and optimized.
- Discuss benefits and risks (eg, addiction, overdose) with patient.
- Evaluate risk of harm or misuse.
- Discuss risk factors with 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 lowest dosage on product labeling; match duration to scheduled reassessment.
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| If renewing without patient visit |
- Check that return visit is scheduled ≤3 months from last visit.
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| When reassessing at 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 risk of harm or misuse:
- Observe patient for signs of over-sedation or overdose risk.
- Check PDMP.
- Check for opioid use disorder if indicated (eg, difficulty controlling use).
- If yes: Refer for treatment.
- Check that non-opioid therapies 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).
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