Reassess the benefits, risks, and need for continued opioid therapy at each visit

Continue opioid therapy only if there is clinically meaningful improvement that outweighs risks to patient safety1

Consider how to discontinue opioid therapy if benefits do not outweigh risks1
  • Evaluate benefits and harms with patients within 1 to 4 weeks of dose initiation or dose increase, and every 3 months (or more frequently) thereafter
  • Because risks of opioids increase with higher doses, prescribers should:

    • Use caution when increasing opioid dosages, increase by the smallest appropriate amount, and reassess benefits and risks for patients at each dose increase
    • Avoid increasing OxyContin to higher dosages and carefully justify decisions to titrate the dose to 60 mg total daily dose (i.e., 30 mg every 12 hours)
  • Evaluate benefits and risks of continued opioid therapy, weighing factors such as:

    • Development of addiction, abuse, or misuse
    • Maintenance of pain control and the relative incidence of adverse reactions
    • Comorbidities and concomitant medicines that may increase the susceptibility of opioid-associated harms
    • Whether opioid therapy is helping your patient meet their treatment goals
    • Other pain treatment options with non-pharmacologic and non-opioid therapies, as appropriate
    • Consultations with a pain specialist as needed to assist in pain management

If benefits do not outweigh harms of continued therapy, optimize other therapies and work with patients to lower the opioid dose or to taper and discontinue the opioid1

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Reference: 1. Dowell D, Haegerich T, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(No.RR-1):1-49. Accessed February 21, 2018.