Table 3. Prescribing Opioids for Short-Term Use or Chronic Pain: Educational Guidelines.

Educate: If you do prescribe opioids, patient education is key. Explain to the patient:

Why opioids are being prescribed and any alternative treatments that may be available Proper use of the pain reliever, side effects The risks and harms of taking unnecessary opioids, including the risks of dependence, addiction, and overdose The importance of keeping all medications out of children's reach The dangers of taking opioid drugs with alcohol, benzodiazepines, and other central nervous system depressants How to properly dispose of unused opioids (see Table 2) Risk associated with diversion, warning never to share a prescription medication Timeline for tapering off opioids and weaning the patient onto nonopioid pharmacological therapy Use a pain management: For those at risk for misuse, consider a “Pain management agreement,” i.e., a written contract or agreement that is executed between a practitioner and a patient, prior to the commencement of treatment for chronic pain using an opioid or other controlled dangerous substance. The aim of such an agreement is to prevent misuse of a prescription pain medication. It also: Documents the discussion between the provider and the patient Establishes the patient's rights and obligations regarding responsible use, discontinuation, refills and storage Lists the nonopioid and nonpharmalogical interventions recommended to complement and eventually replace the opioids as part of the pain management plan Specifies how the provider may monitor patient compliance, including random specimen screens and pill counts Outlines the process for terminating the agreement, including consequences if the provider has reason to believe that the patient is not complying with the terms of the agreement.

Prescribe electronically: When prescribing, use electronic prescriptions for opioids, prescribe for the shortest time reasonable, and consider having the patient return before renewing the prescription. Electronic prescriptions provide improved monitoring and reduce forgery.