1. Physicians must be familiar with and follow the requirements of state and federal law and regulations on the use of the prescription monitoring program prior to initiating opioid treatment.
2. Physicians screen patients for pregnancy, personal or family histories of substance use disorder, mental health status, and relevant behavioral issues.
3. Physicians prescribing opioids inform patients about the cognitive and performance effects of these prescriptions and warn them about the dangers to themselves and others in operating machinery, driving, and related activities while under treatment.
4. Physicians consider referring patients with complex pain conditions, serious comorbidities, mental illness, or a history or evidence of substance use disorder to consultation from a colleague or specialist referral.
5. When clinically indicated, physicians initiate opioids as a short-term trial to assess the effects and safety of opioid treatment on pain intensity, function, and quality of life. In most instances, the trial should begin with a short-acting opioid medication.
6. Physicians prescribe the starting dosage to be the minimum dosage necessary to achieve the desired level of pain control and to avoid excessive side effects.
7. Physicians prescribe for short duration with possible partial fill prescriptions or short term, low dosage, sequential prescription approaches.
8. Physicians should be aware of published dosing guidelines for pediatric patients and consider body weight and age as a factor in treating pediatric patients.
9. Physicians review concurrent prescriptions, including paying close attention to benzodiazepines and other medications that may increase the risks of harm associated with opioid use.
10. Physicians maintain records and engage in patient assessments consistent with state and federal laws.
11. Physicians counsel patients to store the medications securely, never share with others, and properly dispose of unused and expired prescriptions.
12. Patients should have regularly scheduled appointments to evaluate the progress of treatment. Patients and physicians should periodically reassess the need for continued opioid treatment, tapering whenever possible as part of the comprehensive pain care plan.