Prescribing guidelines

CDC Guideline for Prescribing Opioids for Chronic Pain

Released March 2016, the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care. The guideline addresses: 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use.

Information for physicians on the CDC guideline.

Physician groups respond to CDC guidelines

AMDG 2015 Interagency Guideline on Prescribing Opioids for Pain

Washington state was one of the first states to respond to the opioid epidemic. The first edition of the Washington State Agency Medical Directors’ Group opioid guidelines, published in 2007, was the first attempt in the U.S. to reduce prescribing of high doses of opioids associated with unintentional overdose.

In 2015, the AMDG published the third edition of its Interagency Guideline on Prescribing Opioids for Pain. This edition expands focus to include opioid use in acute, subacute, and perioperative pain phases and in special populations; includes sections on tapering and opioid use disorder.

AMDG medical treatment guidelines are published as an educational tool for medical providers caring for patients of state agency programs.

Information for physicians on the AMDG guideline, third edition.

Opioid dose calculator
Use in conjunction with the AMDG guideline to calculate the total daily morphine equivalent dose for prescribed opioids (this calculator should not be used to determine doses when converting a patient from one opioid to another). This Web-based tool works on smart phones, tablets and PCs/Macs.

Assessment tools
Documents and tools found in the AMDG 2010 Opioid Dosing Guideline for Chronic Non-Cancer Pain.

MQAC rules for management of chronic non-cancer pain

The Medical Quality Assurance Commission’s final rules for management of chronic non-cancer pain became effective Jan. 2, 2012. The rules apply to physicians who treat patients with opioids for chronic non-cancer pain (as defined in the rules). The rules do not apply to physicians providing palliative care, hospice care, or other forms of end-of-life care. The rules also do not apply to the management of acute pain related to an injury or surgical procedure.

Visit the WSMA Legal Resource Center for information on the rules.

MQAC technical assistance letter to providers regarding pain rules (Updated: Oct. 19, 2016)
To help allay legitimate concerns from physicians regarding fear of state sanction for treatment of patients on opioids, the Medical Quality Assurance Commission has issued, at the request of the WSMA, a technical assistance letter which addresses three points: the intent of the MQAC pain rules; opioid prescribing levels, and; what counts as a consultation requirement. We’ll update this link as additional guidance from MQAC becomes available.

Washington State Department of Health pain management resources. Includes:

  • FAQ on MQAC’s 2012 pain rules
  • Patient resources
  • Professional resources
  • Legal resources

Group Health: Patients on Chronic Opioid Therapy for Chronic Non-Cancer Pain Safety Guideline

Updated September 2016, the recommendations in this guideline apply to adult patients who are already on chronic opioid therapy for the treatment of chronic non-cancer pain. Group Health’s guideline is consistent with the regulations, and providers adhering to the guideline will be compliant with the law. The guidelines are intended to provide a MINIMUM standard of care, and are based on the legal requirements defined by Washington State Administrative code (WAC).

Find the guidelines on the Group Health website. (Scroll down to Chronic Opioid Therapy for Chronic Non-Cancer Pain)

Group Health has adopted the recommendations of the 2015 Agency Medical Directors’ Group (AMDG) Interagency Guideline on Prescribing Opioids for Pain.

This guideline does not apply to patients receiving palliative, hospice, or other end-of-life care.