Effective pain management has long been a challenging area of healthcare, particularly when it comes to the use of opioids. With the dual risks of inadequate pain control and potential misuse, opioids demand careful handling by healthcare professionals. As an Advanced Practice Registered Nurse or DEA-registered prescriber, your role in ensuring safe and effective opioid prescribing cannot be overstated. This guide explores best practices, tailored to your expertise, empowering you to meet both clinical and ethical standards in patient care. 

Related: Substance Use Disorders and Pain Management: MATE Act Training 

Understanding the role of opioids in pain management 
The FDA approves opioids for moderate to severe pain relief. While they are undoubtedly beneficial in acute pain, cancer-related pain, and palliative care, their use in managing chronic noncancer pain remains controversial. The 2022 CDC opioid prescribing guidelines emphasize a patient-centered and individualized approach, addressing the variable clinical responses patients have to opioids.  

It’s important to remember: 

• Opioids are not a universal solution. They are a tool, not a cure. 
• Each patient is different. Tailor opioid prescribing to the patient’s needs, preferences, and pain level. 
• Integrating other approaches is vital. Pair pharmacologic interventions with nonpharmacologic therapies to improve outcomes and minimize risks. 

Your role as a prescriber is to balance the benefits and risks of opioid therapy carefully, ensuring opioids are used only when other therapies have failed to provide adequate relief.  

Risk mitigation in opioid use  

Identifying suitable candidates for opioid therapy  

Before initiating opioid therapy, assess whether the patient could benefit from a trial. Candidates for opioids include individuals with moderate-to-severe chronic pain who have not found relief through nonopioid or nonpharmacologic methods.  

Key considerations before prescribing opioids:  

-Assess the intensity and impact of pain on daily function. 

-Collaboratively set clear goals, emphasizing measurable improvements in function and quality of life. 

-Discuss potential risks and benefits with the patient to establish shared decision-making. 

Starting with the lowest effective dose   

When beginning opioid treatment, follow these principles for safety: 

• Use the lowest effective dose of immediate-release opioids. 
• Limit prescription quantities based on the expected duration of pain, particularly in acute or postoperative pain scenarios. 
• Avoid extended-release formulations in medically unstable patients or those with highly variable pain intensity. 

Frequent follow-ups are essential to evaluate the effectiveness of therapy and address any potential side effects or concerns. 

Related: Responsible and Effective Opioid Prescribing 

Nonpharmacologic and nonopioid therapies  

Combining opioids with complementary therapies can enhance pain relief while reducing reliance on high opioid doses.  

Nonpharmacologic interventions  

These approaches can address both physical pain and the emotional distress that amplifies it.  

• Cognitive-behavioral therapy (CBT): Helps patients understand and manage the psychological aspects of chronic pain.
• Manipulative therapies: Massage or acupuncture provides targeted relief.
• Palliative radiotherapy: Reduces localized pain caused by serious conditions like cancer.
• Spinal cord stimulation or intrathecal infusion: Options for severe, intractable pain when other methods are ineffective.

Nonopioid pharmacologic options  

Drugs like NSAIDs, antidepressants, or anticonvulsants can complement or even replace opioids depending on the patient’s condition. For example, antidepressants like SSRIs can address pain with a psychological component, such as depression or anxiety.

Counseling patients on safe opioid use  

Patient education is critical to preventing misuse and ensuring that prescribed opioids are used safely.  

Discuss with patients:  

• Proper use of the medication, including adherence to dosing schedules
• The serious risks of misuse, overdose, and respiratory depression
• The importance of secure storage to prevent theft or accidental ingestion
• Disposal methods, such as drug take-back programs or safe flushing for certain medications

Patients and caregivers should have product-specific instructions and understand the signs of overdose or adverse effects, with clear guidance on seeking emergency care if needed. 

Tackling drug diversion  

Opioid diversion is a growing societal issue. Combat this by:

• Writing prescriptions in smaller quantities
• Educating patients about discreet storage
• Referring patients to community “take-back” services overseen by law enforcement, where unused controlled substances can be safely disposed

Addressing opioid use disorder  

Despite best intentions, some patients may develop dependence or misuse opioids. Recognizing the warning signs of opioid use disorder (OUD) is vital. These signs include: 

• Repeated early refill requests or dose escalations without medical justification
• Seeking prescriptions from multiple providers
• Signs of misuse, such as altering medication formulations (e.g., crushing or injecting pills)

Treatment considerations for at-risk patients:  

• Use validated screening tools like the TAPS Tool to assess substance use disorder risk 
• Refer patients with active substance abuse or OUD to specialists or comprehensive treatment programs
• Encourage multimodal therapies, including psychosocial support and pharmacotherapy tailored to individual needs

The role of guidelines in safe opioid prescribing  

The updated CDC guidelines provide a solid framework for safe opioid prescribing. However, clinical judgment remains essential. These guidelines serve more as a compass, not a strict map, allowing prescribers to make individualized decisions based on patient-specific factors.  

By combining evidence-based practices with empathy and collaboration, APRNs and DEA-registered prescribers can mitigate the risks associated with opioids while addressing pain effectively.

Taking the next step toward safer opioid prescribing  

Safe opioid prescribing is both an art and a science requiring vigilance, compassion, and up-to-date knowledge. By integrating best practices such as careful patient selection, ongoing monitoring, and patient education, you can help combat the challenges associated with opioids while improving patient outcomes.  

If you’re ready to deepen your knowledge and protect your patients with cutting-edge guidelines, consider enrolling in specialized courses that prepare you for safe opioid prescribing in a rapidly evolving healthcare landscape. Together, we can ensure safer and more effective pain management for all.  

Copyright © 2025 NetCE.

Contact Us

I

I

About NetCE

Help

Privacy

Do Not Sell My Personal Information