SCOPE of Pain: Safe & Competent Opioid Prescribing Education

Your surgical colleague asks if your patient who is taking buprenorphine for his opioid use disorder should stop before hip replacement surgery and requests your guidance on how to manage postoperative pain in this patient. What will you recommend?

How do you educate your medical director about the importance and benefits of offering medications, such as buprenorphine for the treatment of patients with opioid use disorder?

Your medical director states all patients on chronic opioid therapy should be tapered, as there's no evidence opioids are effective for chronic pain. What is the actual efficacy of opioids for chronic pain?

How will you manage a patient's chronic pain and likely opioid use disorder after her opioid overdose?

A patient with a twisted ankle requests a prescription for oxycodone. How will you respond to his request for opioids for his acute pain?

A patient is afraid receiving postoperative opioid analgesics will result in opioid addiction. How will you educate this patient about the risks and benefits of opioids for managing her postoperative pain?

Your medical director states that over the next six months, all patients on opioids must be decreased below 90 morphine milligram equivalents as per the mandate of the CDC guideline. What does the CDC guideline say about a dosing threshold of 90 morphine milligram equivalents?

You get an anonymous phone call stating your patient, who you've been treating with chronic opioids for chronic pain for the past six months, is selling his opioids. How will you respond to this concerning, anonymous call regarding potential opioid diversion by your patient?

A patient treated with long-term high-dose opioids for chronic pain insists on having her opioid dose increased to improve her pain management and refuses to consider adding other non-opioid medications or accepting referrals to other forms of pain treatment, including physical therapy, cognitive behavioral therapy or acupuncture. How will you respond to this patient's lack of interest in other chronic pain management strategies?

Your patient, who you've been treating with chronic opioids for chronic painful diabetic neuropathy for the past 11 months calls the on-call service asking for an early refill. She states her pain has worsened, she took extra tablets and has run out early.