In the short term, opioids CAN help ease the sometimes debilitating effects of pain, especially acute pain experienced after trauma or surgery. In these scenarios, it’s vital for providers to map out the next steps for pain control and break the cycle.  That’s because in the long-term, these drugs can cause more harm than good.

By Kari Williamson, RN, LNCC, CCM

It might be easy to simply write a prescription for oxycodone or some other opioid when a patient comes in suffering from chronic pain. In fact, many patients dealing with long-term pain have come to expect that they’ll leave the doctor’s office with that prescription in hand.

But our opioid epidemic has forced the healthcare industry to take a critical look at opioid prescriptions and to seek alternatives to pain management. Physicians and health care providers are focused on combating the epidemic. Before prescribing opioids, more and more physicians are using the following guidelines:

  1. Stop using opioids as a regular course of action. Instead, prescribe therapies that don’t include opioids, such as exercise and cognitive behavioral therapy or anti-inflammatories for chronic pain. When they are used, the CDC recommends combining non pharmacological or non opioid pharmacologic therapies.
  2. Plan how to deal with acute and protracted pain complaints.
  3. Strictly limit the number of pills and refills per prescription.
  4. Be aware that opioids aren’t the solution for all kinds of chronic pain. For instance, Harvard Medical School says that opiates for chronic lower back pain carry “big risks with uncertain benefits.”
  5. Ask the patient if any other doctor or clinic has prescribed a pain medication and seek a toxicology screening to ensure there isn’t already an addiction problem. Be sure to follow up with additional screenings.
  6. Sign a pain management contract with the patient – and enforce it.
  7. Check your state’s prescription drug management program database to identify patientswho are obtaining the drugs from multiple providers. New research from Weill Cornell Medicine found that there was a more than 30 percent drop in the rate of prescribing the most addictive class of painkillers – Schedule II opioids – in two dozen states through these databases.
  8. Always prescribe the lowest effective dosage and begin with immediate-release opioids, not extended-release or long-acting opioids, according to the CDC. Never provide more than needed.
  9. Continue to monitor patients who are using opioids and be sure to wean them off the drugs as soon as possible.

U.S. Surgeon General Vivek H. Murthy appealed directly to every physician in the country, asking them to help “turn the tide” on the opioid crisis and urging the profession to take the lead.  “It is important to recognize that we arrived at this place on a path paved with good intentions,” Dr. Murthy wrote. “Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain. The results have been devastating.”

Kari Williamson, BS, RN, LNCC, CCM (kari@mkcmedicalmanagement.com) is the president of MKC Medical Management and works with attorneys, insurance examiners and others within the medical-legal-insurance space to better manage and understand claim issues.

NOTE:  This is the third in a series of posts about our opioid epidemic. Here’s a post about what employers can do, and another focused on what insurers can do.  In the next post on, I’ll look at the role of patients.