Assess Risks and Potential Harms of Opioid Use

Addressing factors that may increase patient risk

The 2022 Clinical Practice Guideline provides recommendations to equip clinicians with the information they need to discuss pain care options with their patients. Before starting and periodically during continuation of opioid therapy clinicians should:

• Offer naloxone when prescribing opioids, particularly to patients at increased risk for overdose:
  • With a history of overdose or a substance use disorder
  • With sleep-disordered breathing
  • Taking higher dosages of opioids (e.g., ≥50 MME/day)
  • At risk for returning to a high dose to which they have lost tolerance (e.g., patients undergoing tapering or recently released from prison)
  • Taking benzodiazepines with opioids (Recommendation 11 from the 2022 Clinical Practice Guideline)
  • For more information and resources about talking with patients, family members, friends, and caregivers about naloxone, visit the Naloxone Toolkit.
• Use additional caution and increased monitoring (Recommendation 7) to minimize risks of opioids prescribed for:
  • Patients with reduced kidney and liver function
  • Patients 65 years and older
• Implement interventions to mitigate common risks of opioid therapy among older adults, such as:
  • Exercise or bowel regimens to prevent constipation
  • Risk assessment for falls
  • Monitoring for cognitive impairment
• Avoid prescribing opioids to patients with moderate or severe sleep-disordered breathing, when possible, to minimize risks for opioid overdose.
• Use PDMP data (Recommendation 9) and toxicology screening (Recommendation 10) as appropriate to assess for concurrent substance use that might place patients at higher risk for opioid use disorder and overdose.
• Assess patients' abilities to safely perform daily work that involves potentially hazardous tasks (e.g., driving, use of heavy equipment, climbing ladders, working at heights or around moving machinery, working with high voltage equipment) when receiving opioids or other medications that can negatively affect sleep, cognition, balance, or coordination.

*To read more information on situations or other specific considerations that are risky for prescribing opioids, see Recommendation 8 of the 2022 Clinical Practice Guideline.