Opioid Prescribing Guidelines

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:

  • Determining When to Initiate or Continue Opioids for Chronic Pain
  • Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation
  • Assessing Risk and Addressing Harms

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.

Opioid Prescribing Guidelines for Emergency Departments and 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.

The purpose of the guidelines is to:

  • Provide safer, more effective care for patients with acute and chronic pain;
  • Improve communication between clinicians and patients about the benefits and risks of using prescription opioids for chronic pain; and
  • Help reduce opioid use disorder and overdose

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. The ILPMP website 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 – St. Joseph’s Healthcare System in Patterson, NJ

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: renal colic, musculoskeletal pain (sprains, strains, or opiate naïve lower back pain), sciatica, headache, and extremity fracture.

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. For more information about the ALTO protocols, click here..

Guidelines from Colorado Chapter of American College of Emergency Physicians (ACEP)

The 2017 Prescribing and Treatment Guidelines: Confronting the Opioid Epidemic 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.

Presentations on Improving Patient Safety

In an ongoing response to the increased misuse of opioids and related deaths, the DuPage County Health Department hosted a symposium, Improving Patient Safety in the Opioid Crisis: What is the Prescriber’s Role? on Wednesday, May 10, 2017 at the Medinah Shrine Center in Addison, IL. Attendees learned about the history, scope and causes of the opioid crisis, how to apply evidence-based guidelines for pain management and had a better understanding of the prescriber’s role in managing the use of opioids, and more.

Click on each of the links below for complete presentation resources:

The Public Health Response to Opioid Use Disorder in DuPage County
Rashmi Chugh, MD MPH, Medical Officer, DuPage County Health Department

How Illinois is Addressing the Opioid Crisis
Kimberly Fornero, Illinois Department of Health and Human Services

Safe Prescribing:  Opioid Efficacy and the Prescriber’s Role
Natalie Kirilichin, MD, George Washington University, Department of Emergency Medicine

Opioid Neuroscience:  Pain Control vs. Euphoria; Adults vs. Adolescents
Celeste Napier, PhD, Rush University Medical Center

Role of Primary Care Physicians in Managing Chronic Pain, Opioid Use Disorder and Referral for Treatment
Elizabeth Salsibury-Afshar, MD, Chicago Department of Public Health