Module B:  Initiation of Treatment with Opioids

Candidate for opioids with consent
(begin in conjunction with a comprehensive pain care plan)
Initiate opioids using the following approach:
  • Use short duration (e.g., 1-week initial prescription)
  • Plan to reevaluate at 30 days of fewer
  • Use lowest effective dose, recognizing that no dose is completely safe
  • A strategy of escalating dose to achieve benefit increases risk and has not been shown to improve function (see Sidebar L).
  • Long-acting opioids should not be prescribed for opioid-naïve individuals (see Appendix D)
    • Recommendation 11. We recommend against prescribing long-acting opioids:
    • For acute pain
    • As an as-needed medication
    • When initiating long-term opioid therapy (Strong against | Reviewed, Amended)​
  • ​Consider alternatives to methadone and transdermal fentanyl (see Appendix D)
  • Assess improvement in pain and functional status and adverse effects
  • Complete risk mitigation strategies (see Sidebar E)
  • Provide medication and overdose education, offer naloxone prescription