CDC Guidelines

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 one of the highest levels of prescribed opioid abuse in the US.
Prescription opioid overdose deaths in the US now exceed those due to heroin and cocaine
combined, approximately 18,000 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.
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 noncancer 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 90mg morphine per day in
our clinic. Doses more than this can lead to a 9-fold increase in overdose death. If you are
receiving more than 90mg 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 a
minimum of quarterly.
7. Methadone deaths exceed all other opioid deaths combined. As a result, if you are receiving
Methadone we 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.

2. 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 or a taper off your sedatives.
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
administering the medication.
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Patient Signature Date