Prescribers of opioids should limit the course to the lowest dose and shortest duration possible.
In some patients physical dependence can develop quickly, making opioid cessation difficult.
The risk of transition from short term to long-term use begins after the fifth day of exposure.
Prescriptions of opioids to patients before the 12 grade is independently associated with a 33% increase in the risk of non-medical opioid use by the age of 23 years.
After a short stay surgery opioid prescriptions for patients are associated with a 44% likelihood to use opioids at one year than were patients who did not receive such a prescription.
In Adolescents and young adults who had not received previous opioid therapy, approximally 5% administered opioids postop continued to receive them 90 days later.
Lowering prescription quantity post procedure decreases the risk of opioid abuse, as 71% of prescribed postoperative doses go unused.
Following laparoscopic cholecystectomy or herniorrhaphy , more than 80% of patients used fewer than 15 opioid doses, suggesting lower prescription quantities should be ordered.
The risk of overdosing on opioids are increased with sleep disordered breathing, end organ dysfunction leading to impaired medication clearance, pulmonary disease and concomitant use of sedating medications.
Counseling patients regarding discarding excess tablets reduces the risk of misuse by others.
Opioids for chronic pain is not supported by strong evidence, and opioids should be used as a last resort when other drug and non-drug therapies have failed.
When opioids are prescribed, objectives should be established at the outset of therapy, with a plan to taper opioids if the goals are not met.
As most adverse drug effects of opioids are related to dose, caution against using excessive dose escalation in the management of chronic pain should be used, except during life ending care.