Introduction From the year 1999 to 2014, the number of prescription opioids in the USA quadrupled. However, even with such an increase, there was no evidence of a reduction of pain the patients experienced. Instead, the number of deaths that resulted from overdoses of opioids increased in the same ratio as the increase in prescription figures. The Center for Disease Control provides safety guidelines for the prescription of opioids for pain alleviation in persons aged 18 years and above, in settings outside medical care facilities such as palliative care centers, and end of life care points(CDC, 2016). This paper provides a summary of the CDC guidelines on the prescription of opioids for chronic pain relief and a regime plan for opioids as APRN.

Summary of main concepts

Determining when to start or proceed with opioids for chronic pain

1. Non-first line or routine chronic pain therapy Opioids

Chronic pain is best handled with nonpharmacologic and non-opioid therapy. Clinicians should consider having opioid treatment on the cards only if the benefits they expect to exceed the risks to the patient under treatment. In case the opioids are prescribed, they should be offered alongside nonpharmacologic therapy and non-opioid therapy, as the situation demands (Dowell, Haegerich & Chou, 2016).

2. Determine and measure the progress towards attainment of goals

Before initiating opioid therapy for chronic pain, healthcare experts should establish the goals for treatment with the patients. They should include realistic goals that will tackle the pain and function of the body. Thus, consideration should be made on how to discontinue therapy when it is realized that therapy is outweighed by the risks to the patient.

Before the onset of opioid therapy, and periodically after that, there should be an open discussion between clinicians regarding the risks involved in using a particular therapy. Realistic benefits should also be outlined. The clinician and patient responsibilities during the therapy should be discussed too (Dowell et al., 2016).

Opioid selection, dosage, duration, follow-up, and discontinuation

1. Make use of immediate-release opioids at the onset

Clinicians should only prescribe immediate-release opioids when starting opioid therapy as opposed to the extended-release ones.

2. Clinicians should stay cautious at any dosage administration and avoid raising it higher, unnecessarily.

3. Clinicians should start with the lowest effective dosage when starting to administer opioids. Caution must be exercised at any dosage. The benefits should be documented, with evidence, carefully, as the opioids are administered. The risks should also be documented if and when the dosage is increased?50 MME, and increasing dosage to ?90 morphine milligrams per day should be avoided. Otherwise, dosage titration to ?90 per day should be justified.

4. Avoid prescribing more than is needed

When the drug is used to alleviate acute pain, healthcare experts should only prescribe the lowest immediate release dose that is effective. They should not raise the dose to higher levels that needed during the treatment span of acute pain that calls for steroid use. Three days of opioid administration should suffice in most cases. It should never go over seven days in whatever circumstances.
5. Provide a taper if the opioids are not seen to act or are harmful

Health experts should review the effect of the opioids administered in one to four weeks of escalated administration. The benefits and the side effects of the opioid prescription and therapy should be reviewed every three months or before then (Dowell et al., 2016). If the benefits are less than the harms of continuous usage of the drugs, then there should be a clear exit plan for the discontinuation of the opioids via tapering strategies to reduce them gradually.

Risk assessment and dealing with the negative effects of opioid usage

1. Identify, evaluate and assess the risks involved of opioid usage

Opioid-related harms should be assessed by clinicians first before they initiate any opioid therapy, or even during the period of the therapy. Healthcare providers should include plans for risk management, such as offering naloxone when there is a host of factors that could increase the risk. Such factors include the history of use disorders, overdose, co-occurring Benzodiazepine usage and the like are present.

2. Inspect PDMP for dangerous combinations and high doses

Healthcare staff should check the patient’s previous usage of controlled substances to make sure that they are not in danger as a result of such usage. Clinicians should make use of PDMP data when administering opioid therapy intermittently or initiating it for chronic pain cases from prescription to after every three months.

3. Conduct urine test for previous use of opioids and other dangerous combinations

Urine drug testing should be the starting point before the administration of opioid therapy. It is best if the urine drug testing is even done annually.

4. Desist from prescribing opioids alongside benzodiazepine.

The above practice should be avoided as much as possible.

5. Subject patients to Opioid use disorder treatment

Medication-assisted treatment or other evidence-based treatment should be offered to patients with complicated drug traces in their system or those with opioid use disorder or those with chronic pain.

Plan for Advanced Practice Registered Nurse (APRN)

The APRNs who handle patients experiencing pain are usually certified, nursing practitioners. Just like their family practice physicians, they do not have education relevant to how to manage pain professionally (Institute of Medicine, 2011). Indeed, over 50% of…