Module 2: Basic Pharmacology of Controlled Drugs and Substances
Opioids – General approaches to management
Because of their psychoactive effects, opioids pose a particular set of challenges to patients and prescribers. It is important, therefore, to keep the following general principles in mind when planning an approach to opioid prescription (NOUGG, 2017):
- Initiating therapy with any opioid must be considered to be a trial that should be discontinued if desired outcomes are not achieved.
- Patient expectations must be managed realistically; there needs to be an open discussion that improved function may be a better benchmark of success than a total resolution of pain symptoms which may not be achieved.
- The dose of the opioid should not be increased if the pain is well controlled and/or functionality improves.
- Non-opioid or non-pharmacologic analgesics or adjuvant agents must be optimized before adding an opioid as a trial (e.g. NSAID for musculoskeletal pain, gabapentinoid for post herpetic neuralgia).
- Referral for alternative therapies, such as regional anesthetic injections, surgical interventions, massage, and acupuncture should be considered.
- A switch in the type of opioid prescribed or in the route of administration may provide a better balance of analgesia vs. adverse effects.
- Adverse effects must be anticipated and managed.