Patients on opioids need to comply with the CDC guidelines. Per the CDC recommendations:

1. Keep opioids to less than 90 mg of equivalent morphine/day. Keep Narcan spray or injections for opioid emergencies if taking more than 50 mg of equivalent morphine/day. If able, taper to the lowest effective opioid dose to control your pain.  Be reasonable with your expectation of pain control and don’t expect to experience total absence of pain

2. Employ multidisciplinary treatment if on opioids: a course of PT and consult a psychologist and to help deal with the stress of chronic pain.

3. To spare further increase in your opioids, with your opioids, use non opioid adjunct pharmacological medications such as anti epileptics (e.g. Gabapentin) and antidepressants e.g. Cymbalta.

4. To spare increased use of opioids during exacerbations, consider a course of PT and/or injections for exacerbations. Instead of taking opioids, in not contraindicated, may take a source course of Nsaid’s e.g. Ibuprofen for few days during periods of exacerbations.

5. Don’t take benzodiazepine e.g. valium, alprazolam, clonazepam, etc. with an opioid. Most fatal overdose is due to using a combination of opioid and a benzodiazepine. Avoid also hypnotics e.g. Ambien and muscle relaxantse.g. Soma.

6. For those with high dose opioids, consider medical marijuana to allow you to taper your opioidswithin the CDC guidelines.

7. We regularly do UDT (urine drug test) and check your use of controlled medications through the Florida PDMP (Prescription Database Monitoring Program). PDMP is a statewide electronic database that tracks all controlled substance prescriptions. A violation may lead to your discharge from our practice.

8. Prevent diversion, misuse and abuse. Don’t share your opioids. Store opioids in secure place and out of reach of others (e.g. visitors, children, family, etc).

9. Dispose unused opioids by disposing to a community drug take-back program or may flush them down the toilet.