CDC Recommendations
CDC Recommendation 4: Opioid naive patients
When opioids are initiated for opioid-naive patients with acute, sub-acute, or chronic pain, clinicians should prescribe the lowest effective dosage. If opioids are continued for sub-acute or chronic pain, clinicians should use caution when prescribing opioids at any dosage, should carefully evaluate individual benefits and risks when considering increasing dosage, and should avoid increasing dosage above levels likely to yield diminishing returns in benefits relative to risks to patients.
Utah Supplemental Recommendations
PRESCRIBE THE LOWEST EFFECTIVE DOSE
When opioids are prescribed for the treatment of chronic pain, prescribers should prescribe the lowest effective dose. Prescribers should use caution when prescribing opioids at any dosage, should carefully re-assess evidence of individual benefits and risks when increasing dosage to greater than 50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to greater than 90 or carefully justify a decision to titrate dosage to greater than 90 MME/day.
The CDC states that although there is not a single dosage threshold below which overdose risk is eliminated, holding dosages below 50 MME/day would likely reduce risk among most patients who would experience fatal overdose at higher prescribed dosages. Use of any dose should be based on incremental functional gains.
Benefits of high-dose opioids for chronic pain are not established. At the same time, risks for serious harm increase at higher opioid doses. Opioid overdose risk increases in a dose-response manner. Dosages of 50 to 100 MME/day increase risks for opioid overdose by 1.9-4.6 times and dosages greater than 100 MME increase risk by 2.0-8.9 times as compared with the risk at 1-20 MME/day.
