This document outlines new opioid prescribing policies for a clinic in response to Oregon's prescription opioid epidemic. The policies include: limiting opioid prescriptions to no more than 120mg of morphine per day; requiring follow up appointments every 3 months for long term opioid users; and promoting non-opioid alternatives for chronic pain conditions that typically do not respond to opioids. The policies aim to reduce overprescription while maintaining patient safety.

1. RESPONSIBLE OPIOID PRESCRIBING FOR CHRONIC NON-CANCER PAIN
Oregon is currently experiencing an epidemic of prescription opioid overdoses. Recent data shows that our
state has the highest level of prescribed opioid abuse in the US. Currently prescription overdose deaths
exceed those due to heroin and cocaine combined, approximately 16,500 people per year. This is a public
health crisis that affects everyone in our community. In order to respond to this epidemic the clinic is
instituting the following opioid prescribing policies for all patients and providers.
1. Multiple medical studies of opioid pain medications have shown that they can reduce chronic pain by at
most 30%. Consequently you should expect no more than 30% pain relief with opioids for chronic non-
cancer pain.
2. Opioids are seldom if ever prescribed on the first visit. Please anticipate this and inform your referring
provider of this policy.
3. Studies have shown that chronic backache, chronic headache, migraine, fibromyalgia syndrome, and
chronic abdominal pain do not respond to long-term opioid treatment. If you have been diagnosed with
one of these conditions we will offer you non-opioid alternatives.
4. The maximum prescribed dose for patients with non-cancer pain is 120mg morphine per day in our
clinic. Doses in excess of this can lead to a 9 fold increase in overdose death. If you are receiving in
excess of 120mg morphine per day you will be offered a weaning protocol or referral to an
addictionologist at your discretion.
5. All patients receiving prescribed opioids shall have a formal signed material risk notice maintained in
their chart documenting they understand and accept the risks associated with opioid use.
6. All patients receiving prescribed opioids beyond three months must be seen in follow- up quarterly.
7. Methadone deaths exceed all other opioid deaths combined. As a result if you are receiving Methadone
your provider will offer you a conversion to a safer alternative.
8. Random urine toxicology and breathalyzer screenings will be performed on all patients receiving
prescribed opioids.
9. The Oregon State Prescription Drug Database will be reviewed regularly to ensure the safety of all
patients receiving prescribed opioids. You must agree to receive all opioid medications from only one
provider/clinic.
10. Co-prescribing opioids and sedatives, benzodiazepines, and/or medical marijuana is avoided in our clinic.
If you are using sedatives, benzodiazepines, or medical marijuana we will offer you non-opioid
alternatives for pain management.
11. Intranasal naloxone – Narcan – is a rescue medication that can reverse opioid overdose. You may be
asked to identify a loved one or friend in your household who will be your designated rescuer in the
event of an opioid overdose. This person will require training in the technique.
MD0002(02032014)PAIN
3680 NW Samaritan Dr. | Corvallis, OR 97330 | Phone: 541-754-1268 | Fax: 541-758-2692 | www.corvallisclinic.com