The Centers for Disease Control and Prevention (CDC) released a review on the effectiveness and risks of opioids, which included recommendations for patients and providers regarding proper management of opioid prescribing. Primarily, the CDC recommends non-opioid therapy as the preferred treatment of chronic pain. These modalities include physical therapy, non-opioid medications, and cognitive behavioral therapy. When conservative interventions fail, opioids may be prescribed as part of a multimodal treatment plan. Clinicians should establish treatment goals with patients and consider how the medications will be discontinued if necessary. Generally, the treatment goal of opioid therapy is to reduce the patient’s pain by 30-40%. To begin treatment, low dose, immediate release opioids should be prescribed. If increasing the dose is necessary, it should be done gradually and the risk of harm should be reevaluated. Clinicians should assess the benefits and harms of continued opioid therapy with patients at least every three months and review prescription drug monitoring program data regularly for high risk combinations or dosages and the identification of multiple providers.
In cases of severe acute illness or injury, each state has guidelines for opioid prescribing. In Pennsylvania, prescriptions should be limited to the amount needed until follow-up and should not exceed seven days. Providers should not prescribe long acting opioid agents such unless the prescription is a part of a properly coordinated treatment plan.