The Arizona Department of Health Services (ADHS) has published the 2018 Arizona Opioid Prescribing Guidelines, which recommends best practices if prescribing opioids. The guidelines were developed with and endorsed by healthcare organizations in Arizona.
The 2018 Arizona Opioid Prescribing Guidelines are an update to those first published by ADHS in 2014. The updated guidelines were developed in direct response to Governor Doug Ducey’s opioid emergency declaration in June 2017.
“By working with leaders in the health industry from the public, private, and higher education sectors, Arizona is on the forefront of developing tools for healthcare providers to address this public health crisis,” Governor Ducey said. “The updated opioid prescribing guidelines are a comprehensive tool that will help ensure responsible prescribing of opioids in our state. I applaud the Arizona Department of Health Services and the industry leaders for developing these guidelines that serve as a blueprint for safer prescribing, which will ultimately help save lives.”
The guidelines address acute and chronic pain and include strategies for managing acute and chronic pain in patients, evaluating patients for opioid use disorder, developing an opioid exit strategy, and how to connect patients with medication-assisted treatment:
ACUTE PAIN
Use non-opioid medications and therapies as first-line treatment for mild and moderate acute pain.
If opioids are indicated for acute pain, initiate therapy at the lowest effective dose for no longer than a 3-5 day duration; reassess if pain persists beyond the anticipated duration.
Do not use long-acting opioids for the treatment of acute pain.
CHRONIC PAIN
Prescribe self-management strategies, non-pharmacologic treatments and non-opioid medications as the preferred treatment for chronic pain.
Do not initiate long-term opioid therapy for most patients with chronic pain.
Coordinate interdisciplinary care for patients with high-impact chronic pain to address pain, substance use disorders and behavioral health conditions.
RISK MITIGATION
For patients on long-term opioid therapy, document informed consent which includes the risks of opioid use, options for alternative therapies and therapeutic boundaries.
Do not use long-term opioid therapy in patients with untreated substance use disorders.
Avoid concurrent use of opioids and benzodiazepines. If patients are currently prescribed both agents, evaluate tapering or an exit strategy for one or both medications.
Check the Arizona Controlled Substances Prescription Monitoring Program before initiating an opioid or benzodiazepine, and then at least quarterly.
Discuss reproductive plans and the risk of neonatal abstinence syndrome and other adverse neonatal outcomes prior to prescribing opioids to women of reproductive age.
If opioids are used to treat chronic pain, prescribe at the lowest possible dose and for the shortest possible time.
Reassess the treatment regimen if prescribing doses ≥50 MEDs.
Counsel patients who are taking opioids on safety, including safe storage and disposal of medications, not driving if sedated or confused while using opioids and not sharing opioids with others.
Reevaluate patients on long-term opioid therapy at least every 90 days for functional improvements, substance use, high-risk behaviors, and psychiatric comorbidities through face-to-face visits, PDMP checks and urine drug tests.
Assess patients on long-term opioid therapy for opioid use disorder on a regular basis and offer or arrange for medication-assisted therapy (e.g. methadone and buprenorphine) to those diagnosed.
Offer naloxone and provide overdose education for all patients at risk for opioid overdose.
Individualize an exit strategy from the use of long-term opioid therapy for chronic pain, while carefully monitoring for risks.