If opioids are needed, prescribe minimum amount to achieve functional improvement.
A. Opioid regimen should be sufficient in managing acute pain only to the point of being able to use non opioid treatments:
• The Centers for Disease Control recommends that a clinician not prescribe Extended Release/Long Acting opioids for acute pain.
• Carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.
• Expect patients to improve in function and pain and resume their normal activities in a matter of days to weeks after an acute pain episode. Strongly consider re-evaluation for those who do not follow the normal course of recovery.
• Assess function and pain at baseline and with each follow-up visit when opioids are prescribed.
• Taper the patient off opioids as early as is feasible by transitioning to non-opioid treatments.
In addition, the State of Washington Agency Medical Directors' Group (AMDG) developed the MED Calculator (Morphine Equivalent Dose Calculator) as part of their 2015 safe prescribing guidelines. Overdose risk approximately doubles at doses between 20 and 49 mg/day MED, and increases nine-fold at doses of 100 mg/day MED or more. Although the 2015 guideline maintains the 120 mg/day MED threshold for consultation and some guidelines have lower dose thresholds ranging from 50 to 90 mg/day MED.