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Opioid Dosing Guideline for Chronic Non-Cancer Pain


Opioid Guideline

2010 Opioid Dosing Guideline


PDF 2010 Opioid Dosing Guideline (927 KB PDF)


The Opioid Dosing Guideline for Chronic non-cancer Pain was originally published in March 2007. Sponsored by the Washington State Agency Medical Directors’ Group (AMDG), the original guideline and this updated version were developed in collaboration with actively practicing providers with extensive experience in the evaluation and treatment of patients with chronic pain. It is intended as a resource for all opioid prescribers treating adult patients for chronic noncancer pain. It does not apply to the treatment of acute pain, cancer pain, or end-of-life (hospice) care.


Retired Versions


PDF 2007 Opioid Dosing Guideline (Retired) (623 KB PDF)


Dose Calculator

Opioid Dose Calculator

 

New Web-based Opioid Dose Calculator now available - completely FREE!


Works on mobile devices such as smart phones and tablets, and on your PC and Mac!


To use the web-based Opioid Dose Calculator for use on your smart phone, tablet, PC, or Mac, click on the link below:

phoneWeb-based Opioid Dose Calculator

  • No download needed!
  • Enter doses in real time –the total MED will be instantly displayed
  • Supports the following mobile devices: iPhones, iPads, Android phones, Android tablets (iOS and Android platforms)
  • Also works on most current web browsers (Explorer, Firefox, Safari, etc.) on your PC and Mac
  • To save for offline use, follow the instructions contained in the web-based calculator

For technical questions or troubleshooting, please click here to contact technical support.


If you wish to use the downloadable Excel version of this calculator, see below:


XLS Opioid Dose Calculator (33 KB XLS)

 

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

 

The use of this calculator requires Microsoft Excel. If you do not have Microsoft Excel but wish to use the calculator, please click here to download the Microsoft Excel Viewer from Microsoft.com

 


Assessment Tools

Assessment Tools


FREE Patient Assessment Tools - Please feel free to print and use in your practice.

Below are documents and tools that are found in the 2010 Opioid Dosing Guideline for Chronic Non-Cancer Pain. While the guideline contains other useful tools, we feel these are the most valuable and efficient. These documents are all in the public domain and are recommended as the best free practical, publically available tools.


PDF Activity Diary (122 KB PDF) New Patient activity diary sample to help track goals and progress
PDF Opioid Risk Tool (65 KB PDF) Screening tool to assess risk of opioid addiction
PDF Opioid Treatment Agreement (51 KB PDF) Doctor/patient agreement samples
PDF DSHS Chronic Pain Agreement (18 KB PDF) Doctor/patient agreement samples
PDF Alcohol Abuse Screening (14 KB PDF) Audit Questionnaire: Screening for alcohol misuse
PDF CAGE-AID - Overview (30 KB PDF) The CAGE-AID is a conjoint questionnaire where the focus has been expanded from alcohol alone to include alcohol and other drugs
PDF CAGE-AID - Questionnaire (27 KB PDF) The CAGE-AID Questionnaire is to be used in conjunction with the CAGE-AID Overview
PDF PHQ-9 - Overview (45 KB PDF) The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression
PDF PHQ-9 - Questionnaire (226 KB PDF) The PHQ-9 Questionnaire is to be used in conjunction with the PHQ-9 Overview
XLS Opioid Dosing Calculator (33 KB XLS) Calculate the total daily morphine equivalent dose (MED) for prescribed opioids

CME Activities

Available CME/CE Activities


The following CME/CE activities are currently available. More to come soon.


  1. Opioid Dosing Guideline and DOH Pain Management Rules Online CME Activity

The Medical Quality Assurance Commission (MQAC), in consultation with the Department of Health (DOH) and the Agency Medical Directors’ Group (AMDG), presents this FREE CME activity that offers four (4) hours of:

  • Category 1 Credits™, Or
  • Washington Board of Pharmacy approved Continuing Education (C.E.) Credit(s)

Pain management is a dynamic and challenging area of medical care. The 2010 legislature passed Engrossed Substitute House Bill 2876 in response to concerns about the consequences and risks of prescribing opioids for chronic, non-cancer pain. The bill required five boards and commissions to adopt rules related to pain management by June 30, 2011.

To meet the 4 hour CME provision in these rules
: The Medical Quality Assurance Commission (MQAC), in consultation with the Department of Health (DOH) and the Agency Medical Directors’ Group (AMDG), offers this free CME (continuing education) package available online and on-demand! This CME package is applicable to the licensees of all five boards and commissions named in this legislation.


This free CME activity is a package consisting of 3 parts:

  1. A 20-minute video on the DOH Pain Management Rules. These rules were developed pursuant to ESHB 2876, passed by the Washington legislature in 2010. The video was produced by the Medical Quality Assurance Commission in consultation with the Washington State Department of Health, the Nursing Care Quality Assurance Commission, the Podiatric Medical Board, the Dental Quality Assurance Commission, and the Board of Osteopathic Medicine and Surgery. (The full text of the rules is available at: www.doh.wa.gov/hsqa/Professions/PainManagement)

  2. The AMDG Opioid Dosing Guideline.

  3. A 40-item test, which you may complete online.

    Click to Begin

 


  1. COPE Training

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.

 

Pain Specialists

Pain Management Specialists & Resources


There are several resources to help you locate a pain specialist, but first, it is important to know who qualifies as a pain specialist. In Washington State, the Department of Health (DOH) adopted rules that define a pain specialist. There are FIVE sets of these rules covering each of the SEVEN licensed provider types that can prescribe opioids (see table below). DOH also released an ‘interpretive statement’ clarifying some of their rule language. The link to all of these rules is:

http://www.doh.wa.gov/hsqa/Professions/PainManagement/meetings.htm

 

Provider Type Board or Commission
Medical Physicians Medical Quality Assurance Commission
Physician Assistants Medical Quality Assurance Commission
Osteopathic Physicians Board of Osteopathic Medicine and Surgery
Osteopathic Physician Assistants Board of Osteopathic Medicine and Surgery
Advanced Registered Nurse Practitioners Nursing Care Quality Assurance Commission
Dentists Dental Quality Assurance Commission
Podiatric Physicians Podiatric Medical Board

There are more resources for finding pain specialists than we can provide here. However, this can be a place to start:

  1. The American Board of Medical Specialties (ABMS) keeps a list of physicians who are board certified in Anesthesiology, Neurology, Physical Medicine and Rehabilitation, and Rheumatology, each of which qualifies as a pain specialist under the new rules. At www.abms.org you may search for providers who practice in your area. This service is free but you must create a user name and password to search their database.


  2. The University of Washington School of Medicine and its academic medical centers offer a toll free consultation and referral service available 24 hours per day 7 days per week. This service helps link you with a faculty physician with expertise in any particular area. To access these services visit, call 800.326.5300, email medcon@washington.edu or visit, http://uwmedicine.washington.edu/Patient-Care/Referrals/Pages/MEDCON.aspx. Click on the tab, “Make a Referral” and then the tab “Expertise” and enter the specialty for which you are seeking assistance.


  3. The University of Washington hosts two telemedicine case conference services where a provider can learn about treatment for chronic noncancer pain (and receive CME) AND submit a patient case (with protected health information redacted) for review and consultation by a broad panel of physician specialists with expertise in pain management. The services are called Project ECHO and Project ROAM. Links to these services are:


  4. Project ECHO: http://depts.washington.edu/anesth/care/pain/echo/overview.shtml

    Project ROAM: http://depts.washington.edu/fammed/roam

     

  5. If no specialist is available near your location, some providers may be able to provide services to patients located some distance from the provider’s office using telehealth technology. Also, some specialists may be able to review records you provide and discuss the patient by phone. Many of these services are payable and are listed on page 10 of the AMDG Opioid Dosing Guideline.

Other Resources

Other Opioid Resources


Physicians for Responsible Opioid Prescribing

The following educational materials are presented by the Physicians for Responsible Opioid Prescribing web site. Please visit www.responsibleopioidprescribing.org for more information.


Opioid Prescribing Guide:

PDF Cautious, Evidence-based Opioid Prescribing (88 KB PDF)

Educational Videos:

Effectiveness for Chronic Pain

Effectiveness for Chronic Pain
(YouTube Length - 6:13)

Addiction is NOT Rare in Pain Patients

Addiction is NOT Rare in Pain Patients
(YouTube Length - 5:35)

High Dose Opioid Therapy

High Dose Opioid Therapy
(YouTube Length - 5:17)

Understanding Physical Dependence

Understanding Physical Dependence
(YouTube Length - 3:16)

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.

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.

 

FAQ

Frequently Asked Questions


PDF FAQ Regarding Opioid Dosing Guidelines (180 KB PDF)




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