Safe Prescribing

Question 1

Why is opioid prescribing for pain a problem?

Answer 1

There is a measurable link between opioid prescribing and corresponding morbidity and mortality
People who are prescribed opioids early after injury, for more than a week, or people who receive a second prescription are more likely to use opioids long-term
Opioids are often unsuccessful at achieving meaningful improvement of pain or function

Question 2

First-line treatment for chronic non-cancer pain

Answer 2

Optimization of non-opioid pharmacotherapy and non-pharmacologic therapy (e.g., CBT, exercise, NSAIDs)

Question 3

Second-line treatment for chronic non-cancer pain

Answer 3

Trial of opioids (including initiation, titration and monitoring of response; discontinue if improvement of pain/function is not achieved)
Recommended dose is 90 mg morphine-equivalents or less

Question 4

Clinical red flags for prescribed pharmaceuticals

Answer 4

Running out early
Multiple self-sanctioned dose increases
Borrowing/sharing medication
Double doctoring
Use of multiple pharmaices
Requests for other psychoactive medictions
Request for specific medication by brand name
Lost/stolen medication
Concurrent use of other substances including alcohol and marijuana
Missing specialist consultations
Expressed preference for short-acting formulations
Opposition to medication and substance use monitoring (urine toxicology, unscheduled pill counts)

Question 5

What is part of the risk assessment

Answer 5

History of presenting complaints
Previous use of prescribed psychoactive pharmaceuticals for this and other conditions
Past medical history
Psychiatric and substance-use history
Social history
General physical exam & bloodwork
Urinalysis