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26th Napa Pain Conference

NPC26-Sa4-A - Best Practices for Prescribing Opioids

Aug 17, 2019 11:00am ‐ Aug 17, 2019 12:30pm


Best Practices for Prescribing Opioids

Target Audience: All clinical providers

Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Improve charting and record keeping in preparation for a medical board review
  • Implement strategies, when appropriate, to taper patients to the lowest effective dose
  • Recognize patients who are at high risk for misuse and/or suspected of seeking inappropriate opioid prescriptions
  • Act on a nuanced understanding of what the 2016 CDC guidelines do, and do not, include


When (do?) “Guidelines” Diverge from “Best Practices”

Mark Schumacher, MD, PhD

Proper Charting & Documentation

Samir Sheth, MD

When Should You Taper (or Not Taper)?

Samir Sheth, MD

Pharmacology & Use of Buprenorphine, Naloxone & Low Dose Naltrexone (LDN)

Avinash Ramchandani, MD, MBA


Almost every patient that we care for will receive some opioid. Opioids represent the mainstay of perioperative analgesic therapy.

Do opioid prescribing guidelines have to be a “no-win” scenario?

Additional Reading

  • Olsen, Y. (2016). The CDC guideline on opioid prescribing: rising to the challenge. JAMA, 315(15), 1577-1579.
  • Davis, M. P. (2012). Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. J. Support Oncol, 10(6), 209-219.
  • Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Van Dorsten, B., Humphreys, K., ... & Hoffman, D. E. (2018). International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering. Pain Medicine, 20(3), 429-433.
  • Corder, G., Tawfik, V. L., Wang, D., Sypek, E. I., Low, S. A., Dickinson, J. R., ... & Scherrer, G. (2017). Loss of μ opioid receptor signaling in nociceptors, but not microglia, abrogates morphine tolerance without disrupting analgesia. Nature Medicine, 23(2), 164.
  • Von Korff, M., Saunders, K., Ray, G. T., Boudreau, D., Campbell, C., Merrill, J., ... & Weisner, C. (2008). Defacto long-term opioid therapy for non-cancer pain. The Clinical Journal of Pain, 24(6), 521.
  • Campbell, C. I., Weisner, C., LeResche, L., Ray, G. T., Saunders, K., Sullivan, M. D., ... & Satre, D. D. (2010). Age and gender trends in long-term opioid analgesic use for noncancer pain. American Journal of Public Health, 100(12), 2541-2547.
  • Kroenke, K., Alford, D. P., Argoff, C., Canlas, B., Covington, E., Frank, J. W., ... & Kravitz, R. L. (2019). Challenges with implementing the centers for disease control and prevention opioid guideline: a consensus panel report. Pain Medicine, 20(4), 724-735.
  • Safavi-Hemami, H., Brogan, S. E., & Olivera, B. M. (2019). Pain therapeutics from cone snail venoms: From Ziconotide to novel non-opioid pathways. Journal of Proteomics, 190, 12-20.
  • Younger, J., & Mackey, S. (2009). Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Medicine, 10(4), 663-672.
    Fields, H. (2004). State-dependent opioid control of pain. Nature Reviews Neuroscience, 5(7), 565.
  • Toljan, K., & Vrooman, B. (2018). Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization. Medical Sciences, 6(4), 82.
  • Younger, J., Parkitny, L., & McLain, D. (2014). The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology, 33(4), 451-459.
  • Cornish, J. W., Metzger, D., Woody, G. E., Wilson, D., McLellan, A. T., Vandergrift, B., & O’Brien, C. P. (1997). Naltrexone pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment, 14(6), 529-534.


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