Here is four quotes from the CDC opiates guidelines:
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”
“Clinicians should consider the circumstances and unique needs of each patient when providing care.”
“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”
“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”
https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/
Please review these important points:
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- Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.
- Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.
- The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch. Residual effects from discontinued long-acting formulations should also be assessed before converting a patient to a new opioid.
- Review the concept of incomplete cross-tolerance:
- The use of high but ineffective doses of a previous opioid may result in overestimation of the converted opioid.
- Ideally, methadone conversions (especially patients who were previously receiving high doses of an opioid) should only be attempted in cooperation with a pain specialist or a specialist in palliative medicine.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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Filed under: General Problems
Thank you Steve as I have a new dr appt this morning. I really needed this information. Say a prayer for me please. Thank you again for doing this series. Btw messenger won’t let me share your posts so I’m sharing them on GAB and wherever else I can get these blog posts out.
I’m going to try to put them the FFPCAN public page as we now over 3000 following.
You can thank Richard Mark for the inability to share my blog posts on FAKE BOOK… I called him out TWO YEARS AGO about being a “virtual panhandler” and – I was told – conning other chronic pain pts out of money and some of them out of their “extra pain meds” and he got pissed and got his harem of minions to file untold number of complaints about my blog – after TEN YEARS – being a SPAMMER… and FAKE BOOK didn’t investigate – just responded.. and no one can share a hyperlink from my blog on FAKE BOOK… FAKE BOOK provides no means to appeal and really no way to actually being contacted by any means