Guidelines agree on opioid risk mitigation strategies

(HealthDay)—Recent guidelines on chronic pain management agree on several opioid risk mitigation strategies, according to a review published online Nov. 12 in the Annals of Internal Medicine.

Teryl K. Nuckols, M.D., M.S.H.S., from the University of California in Los Angeles, and colleagues evaluated 13 guidelines published between January 2007 and July 2013 that address use of opioids for chronic pain management in adults. Guidelines addressing specific settings, populations, and conditions were excluded.

The researchers found that although the guidelines differed greatly in quality, most guidelines recommended that clinicians avoid doses greater than 90 to 200 mg of morphine equivalents per day; have additional knowledge to prescribe methadone; recognize risks of fentanyl patches; titrate cautiously; reduce doses by 25 to 50 percent when switching opioids; and mitigate risks by using risk assessment tools, treatment agreements, and urine drug testing.

"Future research should directly examine the effectiveness of opioid risk mitigation strategies," the authors write.