Guidelines

Focus on Recovery – Spokane Regional Opioid Task Force

Prescribing Guidelines

New Prescribing Rules for Providers

The Washington Medical Commission adopted their opioid prescribing rules on August 22, 2018, with an effective date of January 1, 2019.The goals are to increase public health and safety by reducing opioid abuse and misuse, while ensuring that practitioners continue to treat patients safely and appropriately for pain. They have developed a toolkit for several provider types.

Quick reference guides for:

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 Medicare Part D Opioid Overutilization Policies for 2019

Effective January 1, 2019, CMS announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. This website has several resources including the FAQs and specific downloads for patients, pharmacists and providers.

Tapering Guidelines

Pain Management Opioid Taper Decision Tool – A VA Clinician’s Guide, U.S. Department of Veterans Affairs

The Opioid Taper Decision Tool is designed to assist Primary Care providers in determining if an opioid taper is necessary for a specific patient, in performing the taper, and in providing follow-up and support during the taper.

HHS Tapering Guidelines for Long-Term Opioid Analgesics

This HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics provides advice to clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. In each case the clinician should review the risks and benefits of the  current therapy with the patient, and decide if tapering is appropriate based on individual circumstances.

Pharmacist Toolkit: Benzodiazepine Taper

Long-term use of benzodiazepines has been known to produce complications related to discontinuation, withdrawal symptoms, increased risk of accidental overdose when combined with other central nervous system depressants, persistence of benzodiazepine related side-effects, physical dependence, and benzodiazepines use disorders. From 1996 to 2013, the number of adults that obtained a prescription for a benzodiazepine increased by 67%. Based on information from the National Institute on Drug Abuse, the number of overdose deaths involving a benzodiazepine increased from 1135 in 1999 to 8791 in 2015. Three quarters of the deaths involving a benzodiazepine also involved an opioid. Because of concerns regarding patient safety, several guidelines and expert consensus statements have cautioned against chronic benzodiazepine use, especially in the elderly and other at-risk populations. Though benzodiazepines remain first-line treatments for acute alcohol withdrawal and may be used acutely as anticonvulsants, they should generally be avoided for anxiety disorders, panic disorder, and insomnia. Pharmacists can play a key role in providing education to patients and providers about the value of avoiding benzodiazepines, alternative, safer and more effective agents, and often in helping to directly or indirectly assist in the difficult process of tapering such agents.

Pain Management Guidelines

TIP 54: Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders

This guide equips clinicians with practical guidance and tools for treating chronic pain in adults with substance use disorders. This TIP includes information and resources on patient assessment, talking with patients about medication supply, addiction behaviors, opioid misuse measures, and pain treatment agreements.

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