Opioids are no longer considered the first choice for the treatment of pain. It has actually been several years since Dr. Whiting started a patient on opioids. Most of our patients came to us already on them for many years, starting back when the medical profession thought differently about pain. We now know that we were wrong to use them so freely. But a patient who has been on opioids for so long may have suffered damage to the chemistry of the brain, and may struggle in life without any medication. And so we manage them - we work hard to reduce the dose whenever possible, to stabilize the function and improve the quality of life, and to present alternatives that, if tried, hold the potential to reduce the need for opioids. 

For those who take opioids, there are several things they need to know:

• We follow the 2016 CDC Guidelines for prescribing opioids. 
• All patients taking opioids must sign both a pain contract and an opioid consent form. 
• In accordance with the CDC Guidelines, we do not allow patients taking opioids to also take sedatives like diazepam or clonazepam. These benzodiazepine drugs are very dangerous when combined with opioids. If you have been on a benzodiazepine for some time then we will wean you gently off of the drug. 
• Urine Drug Testing is performed randomly but regularly. Pill counts are conducted on occasion. 
• Prescriptions for opioids may not be obtained outside of an office visit. For many patients the visit frequency is every two months. 
• In accordance with the CDC guidelines, patients taking high doses of opioid will need to be gently and slowly weaned down to acceptable dosages. Potency of opioids are expressed in Morphine Milligram Equivalents (MME). 
• The guidelines recommend doses less than 90 mg MME. If you dose is greater than this, we can only prescribe for you if you allow your dose to be slowly and gently reduced. It has been our experience that patients who have been weaned actually experience less pain. To understand why, read the core articles in Dr. Whiting's Blog.

How do you know if your dose is above the Guidelines? 

Use this Guide from the CDC