Opioid Dosing Guideline for Chronic Non-Cancer Pain

The Opioid Dosing Guideline is part of a year-long educational pilot to improve care and safety when treating chronic non-cancer pain with opioids. The principles in this guideline are intended for use by all providers who prescribe opioids for chronic, non-cancer pain.

It was developed by an Interagency Workgroup on Practice Guidelines in collaboration with actively practicing physicians who specialize in pain management.  This guideline does not apply to the treatment of cancer pain or end-of-life (hospice) care. 

The purpose of Part I of the dosing guideline is to assist the primary care provider who does not specialize in pain medicine in prescribing opioids for adults in a safe and effective manner when:

• Instituting or transitioning opioid treatment from acute to chronic non-cancer pain;
• Assessing and monitoring opioid treatment for chronic non-cancer pain; and
• Weaning opioids if an opioid trial fails to yield improvements in function and pain. 

The purpose of Part II of the guideline is to assist primary care providers in treating patients whose morphine equivalent dose (MED) already exceeds 120 mg per day.

Opioid Dosing Guideline for Chronic Non-cancer Pain (209 KB PDF)

Back to Top

The Agency Medical Directors' Group (AMDG) presents this FREE CME/CE activity that offers two (2) hours of:

• American College of Occupational and Environmental Medicine approved AMA PRA Category 1 Credit(s)™, Or
• Washington Board of Pharmacy approved Continuing Education (C.E.) Credit(s)

Time: After reading the Opioid Guideline, this activity will take approximately 30 minutes.

Target audience: Primary care physicians, pharmacists and others in the medical community.

Learning Objectives : Be able to use Opioid Dosing Guideline tools and prevention strategies to appropriately prescribe and avoid misuse and abuse of opioids.

Click here to begin the Opioid Dosing Guideline CME Activity

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the Joint Sponsorship of the American College of Occupational and Environmental Medicine and the Washington State Agency Medical Directors' Group. The American College of Occupational and Environmental Medicine is accredited by the ACCME to provide continuing medical education for physicians. “The American College of Occupational and Environmental Medicine designates this educational activity for a maximum of two (2) AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.” Approval date: March 26, 2007  |  Expiration date: April 30, 2010

Back to Top

This tool was created to assist providers in calculating the total daily morphine equivalent dose for the prescribed opioids.

Opioid Dosing Calculator (33 KB XLS)

Back to Top

If you need to find a pain management specialist, you may find it helpful to contact one of the physicians on the following list of those willing to provide consultations. This list will continue to be developed and updated.  On page 7 of the guidelines you will also find a list of certification or membership organizations for pain specialists.

Pain Management Specialists Directory (20 KB PDF)

Back to Top

This document was developed to answer questions from a lay audience interested in issues related to the guidelines. In October 2006, a public meeting was held to discuss the draft guidelines.  Questions asked at that meeting are also included in this document.

Frequently Asked Questions Regarding Opioid Guidelines (180 KB PDF)

Back to Top

Methadone Treatment for Pain States Article

The article provides a description of Methadone pharmacokinetics and pharmacodynamics and its usefulness in the treatment of pain. The article illustrates tables and examples of conversion factors for other opioids to equivalent doses of Morphine.

Click here to find out more about this article

JAMES D. TOOMBS, M.D., and LEE A. KRAL, PHARM.D

University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1079, USA.

Abstract:

Methadone is a synthetic opioid with potent analgesic effects. Although it is associated commonly with the treatment of opioid addiction, it may be prescribed by licensed family physicians for analgesia. Methadone's unique pharmacokinetics and pharmacodynamics make it a valuable option in the management of cancer pain and other chronic pain, including neuropathic pain states. It may be an appropriate replacement for opioids when side effects have limited further dosage escalation. Metabolism of and response to methadone varies with each patient. Transition to methadone and dosage titration should be completed slowly and with frequent monitoring. Conversion should be based on the current daily oral morphine equivalent dosage. After starting methadone therapy or increasing the dosage, systemic toxicity may not become apparent for several days. Some medications alter the absorption or metabolism of methadone, and their concurrent use may require dosing adjustments. Methadone is less expensive than other sustained-release opioid formulations. (Am Fam Physician 2005;71:1353-8.)

Opioid Prescribing Education Opportunities

Collaborative Opioid Prescribing Education (COPE) is an online training, created by the University of Washington Medical Center, to improve doctor-patient communication and collaborative goal setting when prescribing opioid(s) to treat chronic, non-cancer pain.

KUOW Broadcast - "The Complexity of Treating Chronic Pain"

On March 8, 2007, Gary Franklin, MD, Joseph Merrill, MD, and Caleb Banta Green, participated in a panel discussion concerning the state's interagency Opioid Dosing Guidelines and the challenges involved when treating chronic pain.

The discussion was aired on Puget Sound Public Radio, KUOW 94.9. To listen to this broadcast, please visit the KUOW Program Archives page.

Return to the Interagency Guidelines page.

Back to Top

About AMDG  |  Privacy and security statement  |  Intended use/external content policy  |  Contact us
© Washington State Agency Medical Directors' Group. Use of this site is subject to the laws of the state of Washington.