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Decreasing Opioid Overdose Risk for New Patients on High-Dose Opioid Therapy for Chronic Pain

January 19, 2018

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.
doctor discussing proper opioid use with patient
  • 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.

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:

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:

This content originally appeared in Claims Rx, our claims-based learning publication available in the searchable Claims Rx Directory. Many releases are available for download and eligible insureds will find instructions for obtaining CME credit for select releases.


* Deborah Dowell, et. al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. 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, Pain Management, Prescribing & Medication, Best Practices, Physician, Opioids



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