5
Risk Assessment, Mitigation, and Universal Precautions
With Opioid Use
➤ Clinicians should assess the potential risks and benefits when
initiating treatment that will incorporate long-term use of opioids.
(Moderate Recommendation; IC-B-I)
➤ Clinicians should clearly understand terminology such as tolerance,
dependence, abuse, and addiction as it relates to the use of opioids
for pain control. (Moderate Recommendation; IC-B-I)
➤ Clinicians should incorporate a universal precautions approach to
minimize abuse, addiction, and adverse consequences of opioid use
such as opioid-related deaths. Clinicians should be cautious in co-
prescribing other centrally acting drugs, particularly benzodiazepines
(Table 5). (Moderate Recommendation; EB/IC-B-I)
➤ Clinicians should understand pertinent laws and regulations
regarding the prescribing of controlled substances. (Moderate
Recommendation; IC-B-I)
➤ Clinicians should educate patients and family members regarding
the risks and benefits of long-term opioid therapy and the safe
storage, use, and disposal of controlled substances. (Moderate
Recommendation; IC-B-I)
• Clinicians are encouraged to address possible myths and misconceptions about
medication use and should educate patients about the need to be cautious when
using alcohol or sedating over-the-counter medications or in receiving centrally
acting medications from other physicians.
Qualifying statement. Education and information about treatment should ideally
take into account the patient's literacy level and the need for interpreters and should be
provided in a culturally congruent manner.
➤ If opioids are no longer warranted, clinicians should taper the dose
to avoid abstinence syndrome. The rate of tapering and the use of co-
therapies to reduce adverse effects should be individualized for each
patient. (Moderate Recommendation; EB/IC-B-I)
