Opioid Prescribing Guidelines
Centers for Disease Control (CDC) Guidelines for Prescribing Opioids
The Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain provides detailed guidelines that are best practice for physicians prescribing opioids for chronic pain. The guidelines include:
- Assessing Risk and Addressing Harms
- Determining When to Initiate or Continue Opioids for Chronic Pain
- Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation
Purpose of the Guidelines
CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.
Prescribing Guidelines for Emergency Departments & Immediate Care Centers
To address the state’s opioid epidemic, the Illinois Health and Hospital Association (IHA) developed Opioid Prescribing Guidelines: For Patients in the Emergency Department and Immediate Care Centers.
These guidelines are meant to assist clinicians in treating patients with acute and chronic pain in the emergency department (ED) and immediate/urgent care settings. These guidelines are not intended for patients who are receiving treatment for cancer, palliative care or end-of-life care.
Purpose of the Guidelines
The purpose of the guidelines is to:
- Help reduce opioid use disorder and overdose
- Improve communication between clinicians and patients about the benefits and risks of using prescription opioids for chronic pain
- Provide safer, more effective care for patients with acute and chronic pain
Prescribing Opioids for Women of Reproductive Age
View this document (PDF) to learn more about pharmacological considerations for pregnant women, neonatal opioid withdrawal syndrome, guidelines for prescribing opioids, managing acute dental pain, and guidelines for discharging women with prescriptions.
Illinois Prescription Monitoring Program (ILPMP)
Those who are prescribing opioids are encouraged to use the Illinois Prescription Monitoring Program (ILPMP). The ILPMP collects information on controlled substance prescriptions dispensed in Illinois and allows prescribers and dispensers to view a current or prospective patient’s prescription history.
All prescribers of controlled substances can access the database free of charge. According to the CDC, "most fatal overdoses were associated with patients receiving opioids from multiple prescribers and/or with patients receiving high total daily opioid dosages." The ILPMP helps prescribers determine if a patient is receiving opioid prescriptions from multiple providers, and assess the risk of overdose in patients who are receiving high doses of opioids or sedating medications such as benzodiazepines.
Model Practices for Safe Prescribing
Alternatives to Opiates (ALTO) Program
The ALTO program is a highly successful and unique approach to acute pain management without the use of opioids. St. Joseph’s Healthcare System was the first in the U.S. to launch this program in January 2016. Initial results from St. Joseph’s ALTO program show that up to 75% of patients have achieved adequate pain relief with different therapies, and a decrease in opioid use by nearly 50% since the program’s inception.
Through the ALTO program, providers are given options to effectively alleviate pain without prescribing addictive medications. The program avoids prescribing opioids for five common conditions:
- Extremity fracture
- Musculoskeletal pain
- Opiate naïve lower back pain
- Renal colic
Alternative therapies offered through the St. Joseph’s ALTO program include targeted non-opioid medications, trigger point injections, nitrous oxide, and ultrasound guided nerve blocks to tailor patient pain management needs and avoid opioids whenever possible. View more information about the ALTO protocols (PDF).
Guidelines from Colorado Chapter of American College of Emergency Physicians (ACEP)
The 2017 Prescribing and Treatment Guidelines: Confronting the Opioid Epidemic (PDF) in Colorado’s Emergency Departments expands emergency department ALTO protocol to include certain cases of abdominal pain, provides discharge medication recommendations, and provides education on ED-based harm reduction techniques.