Opioid Prescribing for Acute Pain

Care for People 15 Years of Age and Older

Click below to see a list of brief quality statements and scroll down for more information.

Quality Statements in Brief

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment
People with acute pain receive a comprehensive assessment to guide pain management.

Quality Statement 2: Multimodal Therapies
People with acute pain receive multimodal therapy consisting of non-opioid pharmacotherapy with physical and/or psychological interventions, with opioids added only when appropriate.

Quality Quality Statement 3: Opioid Dose and Duration
People with acute pain who are prescribed opioids receive the lowest effective dose of the least potent immediate-release opioid. A duration of 3 days or less is often sufficient. A duration of more than 7 days is rarely indicated.

Quality Statement 4: Information on Benefits and Harms of Opioid Use and Shared Decision-Making
People with acute pain and their families and caregivers receive information about the potential benefits and harms of opioid therapy, safe storage, and safe disposal of unused medication at the times of both prescribing and dispensing.

Quality Statement 5: Acute Pain in People Who Regularly Take Opioids
People with acute pain who regularly take opioids receive care from a health care professional or team with expertise in pain management. Any short-term increase in opioids to treat acute pain is accompanied by a plan to taper to the previous dose.

Quality Statement 6: Acute Pain in People With Opioid Use Disorder
People taking buprenorphine/naloxone or methadone for the treatment of opioid use disorder continue their medication during acute-pain events.

Quality Statement 7: Prescription Monitoring Systems
Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed to avoid duplicate prescriptions, potentially harmful medication interactions, and diversion.

Quality Statement 8: Tapering and Discontinuation
People prescribed opioids for acute pain are aware of the potential for experiencing physical dependence and symptoms of withdrawal and have a plan for tapering and discontinuation.

Quality Statement 9: Health Care Professional Education
Health care professionals have the knowledge and skills to appropriately assess and treat acute pain using a multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.

Resources Quality Statements Advisory Committee About

8

Tapering and Discontinuation

People prescribed opioids for acute pain are aware of the potential for experiencing physical dependence and symptoms of withdrawal and have a plan for tapering and discontinuation.

Background

Tapering and discontinuing opioid therapy for acute pain should begin when severe pain has ceased and function has returned. Most people treated for acute pain should generally not require tapering, but they should be aware of the signs and symptoms of withdrawal, as some degree of physical dependence may have developed. At the initial prescription, health care professionals should work with their patients to create a plan for discontinuing opioids as the acute pain resolves and discuss the appropriate disposal of unused opioids.

Reducing the daily dose by about 20% to 25% can reduce the possibility of experiencing withdrawal. People with acute pain treated with opioids at high doses and/or for longer durations may benefit from a period of slower tapering over 5 to 7 days, or longer if necessary. Discontinuing all pain medication is generally indicated, but transitioning to either a nonsteroidal anti-inflammatory drug or acetaminophen can be done when necessary. Continue other non-opioid therapies for any ongoing acute pain management.

Health care professionals should work with people who have been on long-term opioid therapy prior to their acute-pain episode to develop a plan to taper to their baseline dose following the acute-pain episode.

What This Quality Statement Means

For Patients

If you take opioids for more than a week and then cut down or stop quickly, you may experience uncomfortable physical symptoms such as trouble sleeping, muscle aches, diarrhea, upset stomach, and vomiting. If you experience any of these symptoms or have trouble stopping your medication, your health care professional will work with you to make a plan to help you cut down and stop taking opioids safely.

For Clinicians

Ensure people with acute pain who have been prescribed opioids are aware of the potential for developing physical dependence and are aware of the symptoms of withdrawal. Work with your patient to develop a plan to taper and discontinue opioid therapy when functional recovery is achieved. Offer non-opioid therapies to address any remaining acute pain.

For Health Services

Ensure health care professionals have the tools they need to discuss and plan for opioid tapering and discontinuation after acute pain resolves.

Quality Indicators

Process Indicators

Percentage of people prescribed an opioid for acute pain with documentation of receiving information on the potential for physical dependence and symptoms of withdrawal prior to receiving their prescription (aligned with indicator in Quality Statement 4)

Denominator: total number of people with acute pain who were prescribed an opioid
Numerator: number of people in the denominator with documentation of receiving information on the potential for physical dependence and symptom withdrawal prior to receiving their prescription
Data source: local data collection

Percentage of people prescribed an opioid for acute pain with documentation of a plan for discontinuing the opioid

Denominator: total number of people with acute pain who were prescribed an opioid
Numerator: number of people in the denominator with documentation of a plan for discontinuing the opioid
Data source: local data collection

Definitions Used Within This Quality Statement

Opioid withdrawal

Withdrawal symptoms occur when there is a reduction or cessation of opioid use following regular use. Common withdrawal symptoms include the following:

Physical dependence

Physical dependence is a condition caused by the use of opioids in which a sudden or gradual reduction or cessation of drug use causes unpleasant physical symptoms.

Evidence to Improve Care