Initiating chronic opioid therapy: recommended steps
| Step | Details |
|---|---|
| Express empathy, partner with your patient | Empathy signals that the provider has the patient’s best interests in mind Expressing empathy does not commit the provider to prescribing opioid therapy |
| Optimize nonopioid therapy | Utilize nonpharmacologic treatments, adequately dose nonopioid analgesics, and use disease-modifying therapy when appropriate, typically in combination |
| Frame the treatment plan as a therapeutic trial | Opioids should only be continued: If safe and effective At the lowest effective dose, and As one component of a multimodal pain treatment plan |
| Target functional goals | Treatment goals should be based on functional improvement, not pain reduction A useful mnemonic to help identify such goals is SMART: specific, measurable, action-oriented, realistic, and time-bound |
| Obtain informed consent, document thoroughly | Communicate risks, potential benefits, and safe medication-taking practices, including safe storage and disposal of unused opioids Document this conversation clearly in the medical record |
| Employ safe, rational pharmacotherapy | Consider opioid potency, onset of action, and half-life when choosing a medication Comorbid conditions and concurrent prescriptions should affect choice of formulation, dosage, and rapidity of titration Methadone accumulates in adipose tissue and needs to be up-titrated slowly |