Opioid Prescribing Guidelines: When Opioids Should Be Prescribed?

Last Updated: July 8, 2020

Reviewed by Michael Espelin APRN

Many individuals remain unaware of the dangers of opioid abuse, indulging in unsafe practices of opioid use both on and off prescription. America’s opioid epidemic is at an all-time high due to the abuse of prescriptions. A report made in 2016 showed that over 11.5 million US citizens between the age range of 12 and above misused opioid prescriptions. Opioid prescription statistics showed that millions of Americans depended on prescription opioids as the sole medication for chronic pain.

Prescription Opioids Risk Groups

It is a fact that opioid prescribing is a major contributing factor to the endemic drug abuse problem in various communities. To this effect, new guidelines for prescribing opioid pain drugs have been approved to ensure the health, safety, and social security of citizens. However, it is a fact that certain demographics are entitled to prescribed opioids while some others will make do with alternative medications.
Why do doctors prescribe opioids? What specific conditions are doctors prescribing opioids for? Here are exceptional cases that can obtain prescription opioids for therapy.

Patients With Postoperative Pains

A good percentage of surgery patients suffer from extreme pain 24 hours after the local anesthetic has worn off, depending on the type of surgery. The degree of postoperative pain differs as bone and joint-related pains are more intense than those related to soft tissue. Procedures such as Microdiscectomy, inguinal hernia procedure, shoulder, elbow, hand or ankle surgery, and others often require these drugs to regularize.

 woman with an orthosis on the bed

Individuals On Medicare And Social Security Disability Insurance (SSDI)

Essentially, a large percent of disabled Medicare patients are entitled to at least 6 to 13 opioid prescription by state per year. The majority of these individuals are under the age of 65 and are categorized under chronic opioid pain management groups.
Individuals under SSDI who presented with musculoskeletal disorder experienced chronic pain and depression. The opioid prescription and consumption rate is exceptionally higher for these groups, often as high as 100 to 200 milligrams per day. This is often dangerous considering opioid effects and dependency ratio.

Gender Disparities

Research has shown that women make more hospital visits than men and more frequently for pains. Regardless of ethnicity, age, income, and other factors, women were always at a higher percentage of opioid prescription rates than men. Even though deeper research is required to understand the reasons for opioids prescription differences fully, women in various geographic regions have experienced more overdoses and deaths due to prescription drugs than men.

Choosing The Right Opioid

Over the counter pain relievers may not be as effective as RX opioids when it comes to certain peculiar medical conditions. Choosing the right prescription opioid would alleviate pains as well as decrease the risk of dependencies and side effects.

Patients may present with either extreme acute pains or chronic pains which can be tissue or bone-related. The chemical structure of opioids and their mechanisms of action determine if they are suitable for the diagnosed pain. While on the medication, it is important to check in regularly with a doctor, especially if one is experiencing side effects, drug interactions, and peculiarities.
When treating chronic non-cancer pain, regimen should be closely monitored. Here are drug characteristics to consider when choosing the right treatment.

Short-Acting Opioids (Immediate Release)

These are mainly quick-acting pain relievers with very short half-life which ranges from 3 to 7 hours.  Examples of these medications are Hydrocodone, Oxycodone IR, Oxymorphone, Morphine IR, and Codeine Sulfate. These medications are suitable for opioid naïve patients or individuals who have not recently used opiate medications.

Long-Acting Opioids

Patients experiencing constant chronic pains are advised to go for long-acting pain relievers due to their efficacy and longer half-life. They are best suited to patients that have built a tolerance to these drugs. The half-life for this category of drugs can stretch between 3 to 59 hours, depending on the particular medication. Examples of long-acting ones are: Oxycodone CR, Fentanyl, Morphine ER, Methadone, Oxymorphone ER, and Levorphanol.

Patient Status

A few factors to consider when recommending opiates as a treatment regimen for patients include:

  • Age
  • Gender
  • Previous medical history (renal or hepatic problems)
  • Coexisting disorders such as cerebrovascular disease and cardiorespiratory problems
  • Genetic polymorphism.

Drug Factors

Opioid or opiate strength and mechanism of actions often differ depending on their chemical compositions. Drug-related factors to consider include:

  • Metabolism of the drug,
  • Reactions and interactions with CNS depressants and other drugs,
  • Binding strength to receptors.

Guidelines And State Recommendations For Prescribing Opioids

CDC guidelines for prescribing opioids for acute pain, while published in 2016, paved the way for medical establishments to formalize the laws guiding the prescription of opioids.

CDC guidelines for prescribing opioids for chronic pain is in an evolutionary stage. Hence clinicians must endeavor to update themselves on key aspects guiding opiate medication. CDC opioid prescribing guidelines are as follows:

New York State Guidelines

In addition to the general guidelines, the NYC Department of Health and Mental Hygiene added that establishments and medical personnel should assess risks of abuse and addiction, prescribe specifically short-acting ones, confirm all reports of missing prescriptions before replacing with minimal supplies, and all prescriptions are for three days or less.


Following the 2016 opioid regulation laws, all prescriptions should rarely exceed seven days except in acute conditions. It also states that patients may request for less potent ones or fewer pills than is prescribed.


The 2012 Ohio Guidelines affirm that prescriptions should not exceed three days and should only include short-acting pills for acute pain.


The states guidelines included their use for perioperative procedures stressing that postsurgical pain killers should be tapered for acute pains during the first few days to weeks after surgery. They are disallowed for peculiar conditions such as fibromyalgia, headaches, and non-specific pains. Acute pains and extreme medical conditions can be treated with a prescription of 14 days or less. Drug interactions involving other CNS depressants such as anxiolytics, and sedatives should be circumvented.

Doctor Reading Clients Medical Results

Documentation Required When A Doctor Is Prescribing Opioids

In line with the new opioid policy regarding risk factors and the endemic situation, especially in the United States, many states across the country require standard documentation which is obligatory for opioid prescribing by state. These documents include:

  • Clearance document proving a physician-patient relationship,
  • Document of extensive pain diagnosis, history of the condition, history of prescriptions and frequency of refills, reasons for possible discrepancies in dosages,
  • Documentation showing alternative medications discussed and reviewed as well as substance abuse risks,
  • Contracts showing urine drug tests and PDMP consults,
  • Documents showing scheduled monitoring of efficacy, and possible dependence and discussion of opioid withdrawal medications.

Necessity Of Careful Opioid Treatment

Opioids are extremely potent and serve as a relief for patients with chronic pain. However, they have contributed largely to abuse, overdose, and a large number of deaths over the years.

There are many standard rehab facilities in every state in the US. These facilities offer detox medication therapy, 12 step programs, and more, to enable one to recover from dependencies.

Page Sources

  1. Centers for Disease Control and Prevention, CDC Guideline for Prescribing Opioids for Chronic Pain, https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Published on: September 17th, 2019

Updated on: July 8th, 2020

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


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