Module 4: Therapeutics

Lesson 2

Prescribing opioids (cont’d)

The WHO principles for opioid prescribing are:

  • By the mouth: Oral route is the route of administration of choice.
  • By the clock: Analgesic medications for moderate to severe pain should be given on a fixed dose and not on an as needed basis.
  • By the ladder (stepped approach)
  • For the individual: The dosage must be titrated for the individual patient’s pain.
  • Use of adjuvants: To enhance analgesic effects, to control adverse effects of opioids, and to manage symptoms that are contributing to the patient’s pain (e.g., anxiety, depression, insomnia).
  • Attention to detail: Teaching is key. It is important to determine what the patient understands about analgesics and pain relief, and to make sure the patient understands the precise instructions for taking the medication.

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