In 2016, the Centers for Disease Control published an updated guideline for primary care clinicians who are prescribing opioids for chronic pain (outside of active cancer treatment, palliative care, and end-of-life care). It’s an extensive study, with a thorough review of the evidence. But the main message is contained in 12 key points, summarized here:

Determining When to Initiate or Continue Opioids for Chronic Pain

1. Use opioids only when benefits outweigh risks, and combine with non-opioid drugs and non-pharmacologic treatments when appropriate.
2. Establish realistic treatment goals, with a plan for discontinuation.
3. Discuss risks, benefits, and responsibilities with the patient.

1. Begin with immediate-release opioids.
2. Begin with the lowest effective dosage, and assess risks and benefits before increasing.
3. Three days or less will often be sufficient for acute pain, and more than 7 days will rarely be needed.
4. For chronic pain, reevaluate within 1-4 weeks of starting therapy or escalating dose, and then at least every 3 months.

1. Incorporate risk mitigation strategies into the treatment plan, including consideration of naloxone when overdose risk is elevated.
2. Review Prescription Drug Monitoring Program (PDMP) data to help determine risk for the individual patient.
3. For chronic pain, get a urine drug test before starting opioid therapy, and consider repeating at least annually.
4. Avoid prescribing opioids and benzodiazepines together whenever possible.
5. Arrange treatment for patients with opioid use disorder.

You can find the full report here.