DRUG TREATMENT -  Opioids - General Info   
General Pointers

Prescribing Opioids—General Principles
  • Short-acting probably safer for initial therapy, with less risk of inadvertent overdose.
  • Start low and go slow.
  • Use fixed-dose extended-release containing regimens for chronic pain patients.
  • PRN short-acting opiate dosing should comprise less than 1/3 of the overall dosing regimen for any given month. 
  • Consider non-opiates for breakthrough pain.
FDA Risk Evaluation & Mitigation Strategy for prescribers of Extended Release or Long-Acting (ER/LA) opioid analgesics are strongly encouraged to do all of the following:
  1. Train (Educate Yourself) - a REMS-compliant education program offered by an accredited CME provider
  2. Counsel Your Patients – regarding the safe use, serious risks, storage, and disposal of ER/LA opioid analgesics every time you prescribe these medicines
  3. Medication Guide - stress the importance of reading the Medication Guide that they will receive from their pharmacist every time an ER/LA opioid is dispensed to them.
  4. Consider Using Other Tools - including  Patient - Prescriber agreements and risk assessment instruments.
Differences in absorption and metabolism:
  • Long-acting opioids may need more frequent dosing (e.g., long-acting morphine TID)
  • Fentanyl patch q48 hours
  • Only adjust once present dose is at steady state
Differences in pain patterns:
  • Asymmetric dosing (e.g., patient who has more pain before Noon)