--- title: Decreasing Opioid Overdose Risk for New Patients on High-Dose Opioid Therapy for Chronic Pain description: Decreasing opioid overdose risk and transitioning patients to safer pain management when inheriting a patient taking high doses of opioids for chronic pain. image: https://files.norcal-group.com/hubfs/doctor-giving-patient-mediction_soc.jpg --- - [Sign In](https://secure.proassurance.com?hsLang=en-us) - g Search Site [Contact Us](https://www.proassurance.com/contact-us/?hsLang=en-us): **844-466-7225** [![PRA-MMI-Logo®-RGB](https://www.norcal-group.com/hs-fs/hubfs/PRA-MMI-Logo%C2%AE-RGB.png?width=215&height=62&name=PRA-MMI-Logo%C2%AE-RGB.png)](https://www.norcal-group.com?hsLang=en-us)   - [About](https://norcal-group.com/about) - [About Us](https://norcal-group.com/about) - [Coverages](https://norcal-group.com/state) - [Claims](https://www.proassurance.com/report-a-claim/) - [Resources](https://www.norcal-group.com/resources) - [HIPAA Resources](https://proassurance.com/hipaa) - [Website Accessibility](https://proassurance.com/accessibility) - [Pay](https://www.norcal-group.com/pay) ## [Resource Library](https://www.norcal-group.com/library?hsLang=en-us) # Decreasing Opioid Overdose Risk for New Patients on High-Dose Opioid Therapy for Chronic Pain January 19, 2018 - [Tweet](https://twitter.com/share) The most conservative addiction and overdose prevention policies and procedures can’t protect a primary care clinician from inheriting a patient who is taking high doses of opioids for chronic pain. In many cases, because of the patient’s limited resources or the limited number of specialists in the community, primary care clinicians are expected to satisfy the patient’s needs for specialty care, including pain management, mental health, and physical therapy. Although there is no perfect solution for clinicians faced with these challenging patients, the following recommendations can decrease the risk of overdose and increase the chance that patients can be transitioned to safer pain management:* For the latest CDC guiding principles and recommendations for opioid prescribing, see the 2022 *[Clinical Practice Guideline for Prescribing Opioids for Pain](https://www.cdc.gov/opioids/healthcare-professionals/prescribing/guideline/at-a-glance.html)*. ![doctor discussing proper opioid use with patient](https://files.norcal-group.com/hubfs/doctor-giving-patient-mediction_soc.jpg) ### More Information About [Opioid Prescribing](https://www.norcal-group.com/library/opioid-prescribing-for-chronic-pain-case-studies-and-best-practices?hsLang=en-us) for Chronic Pain - [Opioid Prescribing for Chronic Pain: Case Studies and Best Practices](https://www.norcal-group.com/library/opioid-prescribing-for-chronic-pain-case-studies-and-best-practices?hsLang=en-us) - Case Study: [Reducing Opioid Overdose Risk in Patients with Opioid Use Disorder](https://www.norcal-group.com/library/reducing-opioid-overdose-risk-in-patients-with-opioid-use-disorder?hsLang=en-us) - Case Study: [Optimizing Opioid Therapy for Patients with Behavioral Health Disorders](https://www.norcal-group.com/library/optimizing-opioid-therapy-for-patients-with-behavioral-health-disorders?hsLang=en-us) - Case Study: [Strategies for Tapering Patients off Long-Term Opioid Therapy](https://www.norcal-group.com/library/strategies-for-tapering-patients-off-long-term-opioid-therapy?hsLang=en-us) - Case Study: [Pain Management vs. Treating the Underlying Causes of Pain](https://www.norcal-group.com/library/pain-management-vs.-treating-the-underlying-causes-of-pain?hsLang=en-us) - Case Study: [Increased Overdose Risk When Combining Opioids With Other Medications](https://www.norcal-group.com/library/increased-overdose-risk-when-combining-opioids-with-other-medications?hsLang=en-us) - Case Study: [Dismissing a Patient with Chronic Pain and Opioid Dependency Leads to Allegation of Abandonment](https://www.norcal-group.com/library/dismissing-a-patient-with-chronic-pain-and-opioid-dependency-leads-to-allegation-of-abandonment?hsLang=en-us) - Best Practices: [Managing the Risks of Treating Chronic Pain with Opioids](https://www.norcal-group.com/library/managing-the-risks-of-treating-chronic-pain-with-opioids?hsLang=en-us) - Best Practices: [Decreasing Overdose Risk for New Patients on High-Dose Opioid Therapy for Chronic Pain](https://www.norcal-group.com/library/decreasing-opioid-overdose-risk-for-new-patients-on-high-dose-opioid-therapy?hsLang=en-us) - Review the benefits and risks of continued high-dosage opioid therapy with the patient. - Determine whether the patient is achieving any pain or function improvement on current doses. - Offer to collaborate with the patient to taper medications to safer dosages or discontinue opioids. - Do not rush the tapering schedule. Patients who have been taking opioids for many years may require very slow tapers with occasional pauses. - Identify and treat anxiety, depression, and opioid use disorder that may arise during tapering/discontinuing. - Consult with mental health or addiction specialists. - Maximize nonpharmacologic and nonopioid pharmacologic treatments as appropriate. - Consult with a pain management specialist. - Have an opioid prescribing discontinuation plan in place that utilizes pain management policies and protocols for patients attempting tapering or discontinuing long-term opioid therapy. - Consider using a medication termination agreement (e.g., see “[Universal Precautions Revisited: Managing the Inherited Pain Patient, Appendix 1: Termination of Controlled-Substances Agreement](http://painmedicine.oxfordjournals.org/content/10/suppl_2/S115.long)”). ## Resources for Counseling and Managing Inherited Patients on High Doses of Opioids Although limited, there are resources for counseling and managing inherited chronic pain patients who are taking high doses of opioid pain medications, including: - Boston University’s online opioid prescribing course, “[Safe and Effective Opioid Prescribing for Chronic Pain](https://www.opioidprescribing.com/overview).” - Module 5, Case 1-A, of the video case studies provides materials [addressing high-dose opioids in an inherited patient](https://www.opioidprescribing.com/module_5-intro_1a). - Gourlay DL, Heit HA. “[Universal Precautions Revisited: Managing the Inherited Pain Patient](http://painmedicine.oxfordjournals.org/content/10/suppl_2/S115.long).” *Pain Medicine* 2009 Jul; 10 (suppl 2): S115-S123. ## Resources for Tapering and Discontinuing Opioid Pain Medications Opioid tapering and discontinuation should be individualized. The following resources may provide some guidance in constructing tapering/discontinuation policies and procedures for long-term opioid users: - U.S. Department of Veterans Affairs “[Opioid Taper Decision Tool](https://www.pbm.va.gov/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf)” (PDF) - Washington State Health Care Authority “[Tapering Plan for Patient with Chronic, Non-Cancer Pain](http://www.hca.wa.gov/assets/billers-and-providers/taperschedule.xls)” (file download) - McMaster University National Pain Centre “[Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, Appendix B-12: Opioid Tapering](http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b12.html)” This content originally appeared in *Claims Rx*, our claims-based learning publication available in the searchable [*Claims Rx* Directory](https://www.norcal-group.com/claimsrx/?hsLang=en-us). Many releases are available for download and eligible insureds will find instructions for obtaining CME credit for select releases. ## Reference * Deborah Dowell, et. al. *[CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022](http://dx.doi.org/10.15585/mmwr.rr7103a1)*. *Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports* 2022;71(No. RR-3):1–95. November 4, 2022. DOI: 10.15585/mmwr.rr7103a1 Filed under: [Pain Management Specialist](https://www.norcal-group.com/library/topic/pain-management-specialist), [Pain Management](https://www.norcal-group.com/library/topic/pain-management), [Prescribing & Medication](https://www.norcal-group.com/library/topic/prescribing-medication), [Best Practices](https://www.norcal-group.com/library/topic/best-practices), [Physician](https://www.norcal-group.com/library/topic/physician), [Opioids](https://www.norcal-group.com/library/topic/opioids) ###  Topics  Please select Bad Outcomes & Complications Business Continuity Business Operations Community Health Consultations Cosmetic & Reconstructive Procedures Cultural Competency & Cultural Respect Cybersecurity Diagnosis & Testing Digital Practice Electronic Health Records (EHR) General Liability HIPAA Privacy & Confidentiality Industry Trends Information Security Informed Consent Leadership Litigation & Claims Marketing & Practice Building Medical Errors & Apology Medical Ethics Medical Records & Documentation Medication Errors Opioids Pain Management Patient Communication Patient Relationship Personal Finance & Career Philanthropy & Community Involvement Physician Burnout Physician Ratings Physician Wellness Practice Communication Practice Drift Practice Management Prescribing & Medication Public Relations & Communication Regulation & Compliance Reputation Management Unanticipated Outcomes Vicarious Liability ###  Specialties  Please select Emergency Medicine Family Practice Mental & Behavioral Health Obstetrics & Gynecology Oncology Ophthalmology Orthopedics Pain Management Specialist Pediatrics Plastic & Cosmetic Surgery Radiology ### Recently Added Interested in NORCAL Group? **Contact Your Agent/Broker** or call 844.4NORCAL today * NORCAL Group, now part of ProAssurance, includes NORCAL Insurance Company and its affiliated companies. [![AM Best](https://www.norcal-group.com/hubfs/Norcal_Mutual_Images/graphic_am-best.png)](https://www.norcal-group.com/ambest?hsLang=en-us) - [About](https://norcal-group.com/about) - [About Us](https://norcal-group.com/about) - [Coverages](https://norcal-group.com/state) - [Claims](https://www.proassurance.com/report-a-claim/) - [Resources](https://www.norcal-group.com/resources) - [HIPAA Resources](https://proassurance.com/hipaa) - [Website Accessibility](https://proassurance.com/accessibility) - [Pay](https://www.norcal-group.com/pay) © 2001 - 2024 ProAssurance All rights reserved - [844-466-7225 ](tel:18444667225) - [Privacy Policy](https://proassurancegroup.com/privacy-policy?hsLang=en-us) - [Terms of Use](https://www.norcal-group.com/terms?hsLang=en-us) - [Website Accessibility](https://www.norcal-group.com/accessibility?hsLang=en-us) ```json { "@context" : "http://schema.org", "@type" : "InsuranceAgency", "contactPoint" : { "@type" : "ContactPoint", "contactType" : "customer service", "telephone" : "1.844.466.7225" }, "description" : "The NORCAL Group of companies provide medical professional liability insurance to physicians, health care extenders, medical groups, hospitals, community clinics and allied health care facilities throughout the country.", "foundingDate" : "1975-01-01", "foundingLocation" : "California", "legalName" : "NORCAL Mutual Insurance Company", "logo" : "https://files.norcal-group.com/hubfs/Website/Logos/NORCAL-Group-Logo-X-18.png", "name" : "NORCAL Group", "potentialAction" : { "@type" : "SearchAction", "query-input" : "required name=search_term_string", "target" : "http://www.norcal-group.com/search?search={search_term_string}" }, "subOrganization" : [ "Medicus", "FD Insurance", "NORCAL Specialty Insurance Company", "PMSLIC" ], "url" : "http://www.norcal-group.com" } ```