Opioid Crisis and Pain Management

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Learn about the opioid crisis, safe opioid prescribing, and overdose prevention.

Opioids and the Opioid Crisis

Review general information and related resources on opioids and the opioid overdose crisis, including an overview of how the U.S. Department of Health and Human Services (HHS) and the National Institutes of Health are taking steps to combat it. Read about other current national strategies and guidelines to tackle the crisis, such as:

• The U.S. Surgeon General’s Spotlight on Opioids
• NIH’s Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain
• The American Dental Association’s New Policy to Combat the Opioid Epidemic
• The Centers for Disease Control and Prevention's (CDC):
  • Guideline for Prescribing Opioids for Chronic Pain
  • Evidence-Based Strategies for Preventing Opioid Overdose: What's Working in the United States
• The Centers for Medicare & Medicaid Services' CMS Roadmap: Fighting the Opioid Crisis
• The Food and Drug Administration's Opioid Analgesic Risk Evaluation and Mitigation Strategy
• HHS’:
  • Opioid Crisis page
  • Better Pain Management page
  • The HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics
  • Pain Management Best Practices Inter-Agency Task Force

To learn more about the impact of the opioid crisis through experiences and personal accounts from a physician, a first responder, and a patient, check out these three videos.

For insights from NIDA Director, Dr. Nora Volkow, read her blog:

• NIH Partners with the Dental Community to Help Curb the Opioid Crisis
• Million-Participant NIH Study Could Yield Important Insights into Addiction and Pain
• Responsibly and Sensitively Addressing Chronic Pain Amid an Opioid Crisis
• Psychiatrists Should Take a More Active Role in Treating Pain

Opioids, Pregnancy, and Neonatal Care

Pregnancy and the postpartum period are critical times to intervene to help women with unhealthy substance use and their babies. Visit the Opioids, Pregnancy, and Neonatal Care page for practice guidance; research and news; and further education for clinicians on treating opioid-dependent pregnant women, mothers, and infants.

Opioid Prescribing & Pain

Discover resources to help address pain and that you can use in your practice before, during, and after prescribing opioids.

Considerations before Prescribing Opioids

Before prescribing, consider familiarizing yourself with the resources below:

• Commonly Used Long-acting Opioids Chart – A guide for initiating opioid therapy for patients with pain conditions
• Science to Medicine: Managing Patients' Pain: Insights From a Primary Care Provider – Key considerations from a physician about treating patients with pain
• Managing Pain Patients: Assessing the chronic pain patient for opioid abuse potential – Video demonstrating communication approaches between a chronic pain patient and health care provider
• Improving Opioid Prescribing – A factsheet summarizing the role opioid prescribers can play in stopping the opioid epidemic
• Promoting Safer and More Effective Pain Management – A factsheet from the CDC about opioids and recommendations to improve doctor and patient communication
• Prescribing Opioids to Addicted Populations – An article from the School of Nursing & Health Studies at Georgetown that includes options for non-opioid/alternative treatments for pain and a step-wise approach to pain management

Visit the NIDAMED Health Professions Education page for continuing education courses related to opioids.

Patient Forms

• Sample Informed Consent Form – For patient reference prior to initiation of opioid therapy for pain.
• Sample Patient Agreement Forms – Example forms detailing terms and conditions of long-term opioid therapy for pain.
• Administering a Narcotic Contract – Web-based annotated video illustrating how to implement a narcotic contract with a patient.

Monitoring Opioid Prescriptions

• Aberrant Drug Taking Behaviors Information Sheet – Resource listing behaviors more and less likely to indicate prescription medication misuse or addiction.
• Recognizing Opioid Abuse – Table listing common symptoms of prescription opioid abuse and/or addiction.
• Science to Medicine: Screening for Substance Use in the Pain Management Setting – Key considerations from a Doctor of Physical Medicine and Rehabilitation/Pain Medicine Specialist about screening for substance use disorder and what to do next if the patient screens positive

Changing or Discontinuing Opioids

• How to Change Routes of Administration of Opioids – Dosing guidelines for use when changing routes of administration of commonly used opioid analgesics.
• Sample Notification of Discontinuation of Opioid Treatment Form – Form used to provide patients with information about why opioid treatment can no longer be provided and information about local treatment programs
• Knowing When to Say When: Transitioning Patients from Opioid Therapy – A course that covers how to recognize aberrant drug-taking behaviors, strategies for monitoring patients, using a risk-benefit framework to help determine options for discontinuation of opioids, and strategies for transition patients off of opioids and how to treat opioid withdrawal symptoms.

Find additional opioid prescribing resources for prescribers, pharmacists, and patients from the Boston Medical Center TOPCARE (Transforming Opioid Prescribing in Primary Care) team.

Pain Resources

View the research and learn more about managing different types of pain with these tools:

• NIH Pain Consortium
• Nonopioid Treatments for Chronic Pain (CDC)
• Postpartum Pain Management (ACOG)
• Chronic Pain and Safe Opioid Prescribing (ACP)
• Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain
• Resources on Pain Management and Anesthesia
• Managing Chronic Pain (CAFP)