style, literacy, culture, language and physiological barriers. When providing information, prescribers and dispensers should emphasize key points, speak slowly and avoid medical jargon. Prescribers and dispensers should review any handouts or materials with the patient prior to providing them to the patient, using resources as supplement to, rather than substitute for, one-on-one patient education. Prescribers and dispensers should include family members in patient education whenever possible. Patient education relating to pain management should include the risks and realistic benefits of each therapeutic option. Risks of opioid use may include, but are not limited to, overdose, misuse, diversion, addiction, physical dependence and tolerance, interactions with other medications or substances, Establish an Exit Strategy Prior to initiating opioid therapy, prescribers should develop a longitudinal treatment plan for the management of the patient’s pain. This plan should be established with the patient, particularly as it relates to how treatment effectiveness will be established and setting realistic goals for pain and function. This plan should highlight how and when opioid therapy will be discontinued, linking the
and death. When alerted to these risk factors, patients can make more informed decisions about their treatment options. For example, some patients have reduced, discontinued or forgone opioids when alerted to the risk factors. Prescribers should also ensure patients are provided with information on dose, administration, side effects, effects of opioids on the safe operation of a motor vehicle or heavy machinery, potential medication or substance interactions, risks to family members who may come into contact with the drug, and the safe use, storage, and disposal of opioids. See the Appendix for resources on safe disposal. Pharmacists should offer to review information with the patient about dose, side effects, medication or substance interactions, risks, disposal, and other applicable topics. discontinuation of the therapy to the achievement of functional goals. The prescriber should further ensure the patient is aware that opioid therapy should be discontinued, absent clinically significant improvement in pain and function or when the risks of opioid therapy outweigh the benefits. This plan is also an opportunity for the prescriber to detail the responsibilities of the patient and the prescriber in the management of the patient’s pain.
WHEN PRESCRIBING OR DISPENSING
Verify a provider-patient relationship. A bona fide provider-patient relationship must exist. The prescriber or dispenser should verify the patient’s identification prior to prescribing or dispensing opioids to a new or unknown patient. For pharmacists, this includes exercising judgment and conducting research (such as use of the PDMP Prescribing Safeguards Prescribers should ensure the dose, quantity, and refills for prescription opioids are appropriate to improve the function and condition of the patient, at the lowest effective dose and quantity, in order to avoid over-prescribing opioids. Factors that have been associated with adverse outcomes include: 1) opioid doses greater than 50 morphine milligram equivalents per day; 2) long–acting or extended relief formulations; and, 3) treatment exceeding 3 to 7 days for acute pain and 90 days for chronic, non-cancer pain. Risk mitigation strategies have been found to reduce these risks. Dosage When initiating and throughout continuing opioid therapy, prescribers should prescribe the lowest effective dosage. Opioid doses greater than 50 morphine milligram equivalents (MME) per day is a dosage that the Boards and the Centers for Disease Control 7 agree is more likely dangerous for the average adult (chances for unintended death are higher) over which prescribers should use clinical judgment, invoke additional risk mitigation
or communication with the prescriber or relevant pharmacies) when the prescription order is: For a new or unknown patient; ● For a weekend or late day prescription; ● Issued far from the location of the pharmacy or patient’s residential address; or, ● Denied by another pharmacist. strategies, consult a specialist or refer the patient to a specialist. Pharmacists and dispensers should exercise greater caution in such instances. When determining dosage, prescribers should consider patient medications including, but not limited to, benzodiazepines, that are known to potentiate the effects of opioids and health conditions that may affect that patient’s ability to process and excrete the drug. In addition, prescribers should exercise caution when determining dosage using dose calculators, particularly when prescribing methadone. 8 See the Appendix for additional resources regarding dose calculators. Formulation Long-acting or extended relief opioids increase the risk of overdose in opioid naïve patients. 9 In addition, patients who begin opioid therapy with long-acting opioids are over 4 times more likely to use opioids long term than patients who begin opioid therapy with immediate release formulations. 10 Prescribers should not prescribe long-acting or extended relief opioid formulations for the treatment of acute pain,
Book Code: MDCO1025
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