Eight Prescribing Guidelines

Deaths caused by overdose of prescription drugs are on the rise. Data are incomplete but there is reliable evidence that the reasons are multifactorial. To lower your patient’s risk of overdose from prescribed opioids and other psychotherapeutics, observe the following guidelines:

Evaluate patients for risk of abuse before starting opioid therapy and manage accordingly.
Watch for and treat co-morbid mental disease when it occurs.
Use conventional conversion tables cautiously when rotating from one opioid to another.
Advise your patients to avoid combining benzodiazepines with opioids, especially during sleep hours.
Start methadone at a very low dose and titrate slowly regardless of whether the patient is opioid tolerant or not.
Assess for sleep apnea in patients on high daily doses of methadone or other opioids and in patients with a predisposition for the condition.
Tell patients on long-term opioid therapy to reduce opioid dose during upper respiratory infections or asthmatic episodes.
Avoid using long-acting opioid formulations for acute post-operative or trauma-related pain.