Opioid

The clinician must navigate evidence-based opioid prescribing within the context of the opioid epidemic, balancing adequate pain management with harm reduction. Acute pain management follows multimodal protocols combining non-opioid analgesics, regional anesthesia, and short-course opioids at the lowest effective dose. Chronic pain management requires comprehensive assessment, risk stratification using the Opioid Risk Tool, prescription drug monitoring program (PDMP) checks, treatment agreements, and consideration of non-opioid alternatives. For chronic opioid therapy, the concept of morphine milligram equivalents (MME) guides risk assessment: doses >50 MME/day double the overdose risk, and doses >90 MME/day are associated with significantly increased mortality. The clinician prescribes opioid agonist therapy (buprenorphine, methadone) for opioid use disorder and manages naloxone co-prescribing for patients at overdose risk.