A position paper from the American Academy of Neurology on the prescription of opioids for noncancer pain outlines “best practices” clinicians should follow to reduce patients’ risk for opioid overdose. These practices, published in Neurology, are:
• At each patient visit, track pain and function using a validated instrument, and document the dose of all opioid sources.
• Review state Prescription Drug Monitoring Program data, and conduct random drug urine testing at the time of first opioid prescription and when starting or maintaining chronic opioid therapy. Frequency of follow-up depends on abuse risk.
• Screen for histories of substance abuse, depression, anxiety, and posttraumatic stress disorder.
• Use a “patient treatment agreement.”
• Prescribe doses above 80 to 120 mg/d morphine equivalent dose only when the patient has “sustained meaningful” pain and function improvements, in consultation with a pain management specialist.