Responsible and Effective Opioid Prescribing _ ____________________________________________________
APPENDIX: WISCONSIN MEDICAL EXAMINING BOARD OPIOID PRESCRIBING GUIDELINE
SCOPE AND PURPOSE OF THE GUIDELINE To help providers make informed decisions about acute and chronic pain treatment—pain lasting longer than three months or past the time of normal tissue healing. The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care. Although not specifically designed for pediatric pain, many of the principals upon which they are based could be applied there, as well. Opioids pose a potential risk to all patients. The guideline encourages providers to implement best practices for responsible prescribing which includes prescribing the lowest effective dose for the shortest possible duration for post-operative care and acutely-injured patients. Identify and treat the cause of the pain, use non-opioid therapies Use non-pharmacologic therapies (such as yoga, exercise, cognitive behavioral therapy and complementary/alternative medical therapies) and non-opioid pharmacologic therapies (such as acetaminophen and anti-inflammatories) for acute and chronic pain. Don’t use opioids routinely for chronic pain. When opioids are used, combine them with non-pharmacologic or non-opioid pharmacologic therapy, as appropriate, to provide greater benefits. Start low and go slow When opioids are used, prescribe the lowest possible effective dosage and start with immediate-release opioids instead of extended-release/ long-acting opioids. Only provide the quantity needed for the expected duration of pain. Close follow-up Regularly monitor patients to make sure opioids are improving pain and function without causing harm. If benefits do not outweigh harms, optimize other therapies and work with patients to taper or discontinue opioids, if needed. What’s included in the guideline? The guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, treating the cause of the pain, closely monitoring risks, and safely discontinuing opioids. The three main focus areas in the guideline include: 1. Determining when to initiate or continue opioids – Selection of non-pharmacologic therapy, non-opioid pharmacologic therapy, opioid therapy – Establishment of treatment goals – Discussion of risks and benefits of therapy with patients 2. Opioid selection, dosage, duration, follow-up and discontinuation – Selection of immediate-release or extended-release and long-acting opioids
– Dosage considerations – Duration of treatment – Considerations for follow-up and discontinuation of opioid therapy 3. Assessing risk and addressing harms of opioid use – Evaluation of risk factors for opioid-related harms and ways to mitigate/reduce patient risk – Review of prescription drug monitoring program (PDMP) data – Use of urine drug testing
– Considerations for co-prescribing benzodiazepines – Arrangement of treatment for opioid use disorder
PRESCRIPTION OPIOID GUIDELINE 1. Pain is a subjective experience and at present, physicians lack options to objectively quantify pain severity other than by patient reported measures including pain intensity. While accepting the patient’s report of pain, the clinician must simultaneously decide if the magnitude of the pain complaint is commensurate with causative factors and if these have been adequately evaluated and addressed with non-opioid therapy. 2. It is best practice for a practitioner to consider guidelines within their specialty when prescribing opioids. 3. In treating acute pain, if opioids are at all indicated, the lowest dose and fewest number of opioid pills needed should be prescribed.
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MDWI1625
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