Table of Contents

Part I: Principles of Prescribing Opioids

Section 1

Starting Points

Current Consensus on Opioids in Chronic Non-Malignant Pain

Patient Education and Self-Management

Patient Information *

Section 2

Opioid Prescribing and Oregon Law

Referral Letter Re: Management of Chronic Pain *

Patient Informed Consent Form *

Intractable Pain Checklist *

Section 3

Medication Contracts

Medication Contract - Long Form *

Medication Contract - Short Form *

Getting the Best Result from Opioid Pain Medication: A Partnership Agreement *

Section 4

Chronic Pain and SubStance Abuse

General Principles

Further Considerations

Special Considerations

Coordination of Care with Addiction Treatment Programs

Section 5

Coordination of Chronic Pain and Mental Health Treatment

Mind and Body

Care Coordination Between Treating Providers

Authorization for Use or Disclosure of Health Information *

* print-ready forms

Part II: Guide to Prescribing Opioids For Chronic Non-malignant Pain

Section 1

General Principles

Section 2

Conducting an Opioid Trial

General Principles

Initiation Opioid Therapy

Selecting an Opioid

Assessing Response

Section 3

Converting Opioids After a Successful Trial: Equianalgesic Dosing

Equianalgesic Dose Charts

Conversions

Section 4

Converting from Short-Acting Opioids to Long-Acting Morphine

General Principles

Initiating Long-Acting Morphine

Section 5

Converting from Short-Acting Opioids to Methadone

General Principles

Converting Short-Acting Opioids to Methadone

Section 6

Converting from One Long-Acting Opioid to Another

Issues to Consider

Converting Among High Doses of Opioid

Converting Long-Acting Opioids to Methadone

Converting from OxyContin to Long-Acting Morphine or Methadone

Conversions Involving Transdermal Fentanyl (TDF)

Section 7

PRN Dosing for Breakthrough Pain

Section 8

Anticipating and Managing Common Opioid Adverse Effects

Allergy

Constipation

Dry Mouth

Nausea and Vomiting

Opioid Toxicity

Pharmacological Tolerance

Respiratory Depression

Sedation

Withdrawal

Prescribing in the Elderly

Appendices

Appendix A

Opioids on the CareOregon Formulary – Dosing and Cost Guide

Appendix B

Drug Monographs

Morphine

Transdermal Fentanyl

Methadone

Oxycodone

Appendix C

Equianalgesic Dose Ratios (EDRs)

Appendix D

Adjuvant Analgesics

Antidepressants and Anticonvulsants

Skeletal “Muscle Relaxants”

Appendix E

Pain Scale and Brief Pain Inventory

Appendix G

Additional Resources

References