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OHA Publishes Statewide Acute Opioid Prescribing Guidelines

Thursday, November 15, 2018   (0 Comments)
Posted by: Patrick Chapman, ND | Legislative Committee
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The Oregon Health Authority released the Oregon Acute Opioid Prescribing Guidelines after
House Bill 2114 passed, in an effort to help clinicians working in surgical, dental, primary
care, emergency and urgent care settings, make evidence-based prescribing decisions
when treating pain. Opioid painkillers are powerful medications that come with risks. While
they're effective in treating acute, non-cancer pain, high doses and long-term use could
lead to dependence, abuse, overdose and death. In Oregon, five people per week die
of opioid-related overdoses.

The guidelines, developed in consensus with an external workgroup representing public
health, health care and coordinated care organization leaders, build on Oregon prescribing
guidelines for chronic pain, published in 2016. The acute prescribing guidelines focus on
acute pain management for patients who are new to opioids. They are not intended for
those who currently receive opioids nor for those with a history of substance use disorder.

Common examples of relevant clinical situations include: wisdom teeth extractions, sports
injuries and post-surgical pain management. It is common practice for patients to be
prescribed 30-day prescriptions in these settings. The new guidelines advise that the
lowest effective dose of short-acting opioids be prescribed for no more than three days
in most cases.

"While opioids are effective medications in acute pain management, many people do not
use all of the pills that are prescribed by their doctors after an acute event," said Katrina
Hedberg, MD, state health officer at OHA. "What this tells us is that patients may not need
as many pills as we think, and other forms of pain management may be safer and just as
effective. It also tells us that there are many excess pills sitting in medicine cabinets, which
could be misused or stolen." The guidelines could also help prevent patients with acute
pain from becoming dependent on opioids long term. According to a 2017 analysis by the
Centers for Disease Control and Prevention, 30 percent of those who receive an initial
30-day prescription of opioid painkillers remained on opioids a year later.

In general, the guidelines advise against using opioids as the first-line therapy for mild
to moderate pain. If opioids are deemed appropriate and likely effective for the patient,
the guidelines emphasize the following principles:
1. Evaluate the patient.
2. Assess history of long-term opioid use or substance use disorder.
3. Check the Prescription Drug Monitoring Program, which tracks prescribed controlled
substances such as opioids and benzodiazepines.
4. Provide patient education.
5. Prescribe the lowest effective dose of short-acting opioids for no more than three
days in most cases and no more than seven days in cases of more severe acute pain.
6. Provide follow-up and reassess pain, healing and function.
7. Implement, monitor and document pain management practices to ensure care safety
and quality.

The full guidelines can be found on the OHA website at

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