CDC Guideline for Prescribing Opioid for Chronic Pain, 2016: 12 recommendations (abbreviated)
| 1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain |
| 2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients |
| 3. Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy |
| 4. When starting opioid therapy for chronic pain, clinicians should prescribe immediate release opioids instead of long-acting opioids |
| 5. When opioids are started, clinicians should prescribe the lowest effective dose (use caution when increasing above 50 morphine milligram equivalents and avoid increasing to 90 morphine milligram equivalents per day or greater) |
| 6. Long-term opioid use often begins with treatment of acute pain; when used for acute pain, prescribe the lowest effective dose of immediate release opioids, and prescribe no greater quantity than needed for the expected duration (typically ≤7 d) |
| 7. Clinicians should evaluate benefits and harms with patients within 1-4 wk of starting opioid therapy for chronic pain or of dose escalation (then see at least every 3 mo) |
| 8. Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms |
| 9. Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program data |
| 10. When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider repeating at least annually |
| 11. Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible |
| 12. Clinicians should offer or arrange evidence-based treatment of patients with opioid use disorder |
| 1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain |
| 2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients |
| 3. Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy |
| 4. When starting opioid therapy for chronic pain, clinicians should prescribe immediate release opioids instead of long-acting opioids |
| 5. When opioids are started, clinicians should prescribe the lowest effective dose (use caution when increasing above 50 morphine milligram equivalents and avoid increasing to 90 morphine milligram equivalents per day or greater) |
| 6. Long-term opioid use often begins with treatment of acute pain; when used for acute pain, prescribe the lowest effective dose of immediate release opioids, and prescribe no greater quantity than needed for the expected duration (typically ≤7 d) |
| 7. Clinicians should evaluate benefits and harms with patients within 1-4 wk of starting opioid therapy for chronic pain or of dose escalation (then see at least every 3 mo) |
| 8. Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms |
| 9. Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program data |
| 10. When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider repeating at least annually |
| 11. Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible |
| 12. Clinicians should offer or arrange evidence-based treatment of patients with opioid use disorder |