Reprint requests to:
Melissa B. Weimer, DO, MCR
Oregon Health & Science University
Division of Internal Medicine & Geriatrics
3181 SW Sam Jackson Park Road, L-475
Portland, OR 97239, USA.
E-mail: weimerm@ohsu.edu

Guideline for Safe Chronic Opioid Therapy Prescribing for Patients with Chronic Non-Cancer Pain

Melissa Weimer,DO,MCR1, Nicholas Gideonse,MD2, Kim Mauer,MD3, Brett Stacey,MD3
Departments of 1Medicine, 2Family Medicine, 3Anesthesiology and Perioperative Medicine

©Oregon Health & Science University, 2013, all rights reserved.

For a downloadable version of this guide (suitable for printing), please click here

Topic Outline (Click the links to view topic detail) Topic Detail
Population
      Chronic Non-cancer Pain (CNCP) Definition
      Chronic Opioid Therapy (COT) Definition
The Role of Opioids for Chronic Pain
What to do PRIOR to prescribing opioids
      Assess Health, Pain, and Functional Status
      Assess and Manage Opioid Risks
What to do when prescribing long term opioids
      If opioids are prescribed, consider opioids a TRIAL only
      What to do when benefits outweigh risks and opioid are prescribed past 30-90 days
How to Follow up and Monitor patients prescribed chronic/long-term opioids
      How to perform an opioid benefit-to-harm evaluation
      How to monitor opioid doses
      When to consider a specialty referral
      What to do when diversion is suspected
      What to do when the risks of opioids outweigh the benefits
      What to do when there are concerns for addiction
Inpatient Transitions of Care/Communication
Tapering off Opioids
TABLE 1: OUTPATIENT Opioid Detox Therapies
TABLE 2: INPATIENT Opioid Detox Therapies
Disposing of Opioid Pain Medications
APPENDIX
      Oregon Medical Board Pain Management Website
      TABLE 3: Suggested Opioid Starting Doses
      TABLE 4: Maximum Morphine Daily Equivalents (MED) Chart
      Opioid Conversion Chart
      Examples of how to calculate Morphine Equivalent per Day (MED)
      TABLE 5: Patterns that Suggest Addiction versus Therapeutic Use
      Sample Patient Opioid Handout
      Opioid Side Effects
      Opioid Detox Instructions for patients
     TABLE 6: Portland Area Substance Abuse Treatment Centers