Updated Opioid Guidelines for State Medical Boards 

Updated Opioid Guidelines Released for State Medical Boards – June 23, 2017 – By Kelly Rehan

“Guidelines emphasize individual treatment as opposed to rigid standards.”

The Federation of State Medical Boards (FSMB) released updated guidelines for using opioid analgesics to manage chronic, non-cancer pain. 

The updated document, which stresses safety through an individualized treatment approach, aligns with recent opioid advisories from the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA).  

The guidelines clearly lay out

  • what you should consider in advance of prescribing,
  • how you should evaluate,
  • what you should be monitoring, and
  • what outcomes you should look for,

said Bob Twillman, PhD, FAPM, executive director of the Academy of Integrative Pain Management.

“Plus, it shares what to do if the treatments aren’t working, which is novel in these kinds of guidelines.”

Highlights From the Guidelines

The following are key points practicing pain specialists should know from the updated opioid guidelines:

  • Patient evaluation and risk assessment: Clinicians should understand both the patient’s personal and family history of mental health disorders before prescribing opioids. Patients should also receive a mental health screening as part of the initial evaluation.
  • Starting and discontinuing opioids: Nonopioid and nonpharmacologic first-line treatments, with opioids used only after those conservative treatments have failed. When starting a course of opioid therapy, clinicians should have a strategy for discontinuing or tapering of opioid therapy.
  • Keeping the patient informed: Patients should have full understanding of the risks, benefits, and proper use of opioid therapy. Written informed consent and treatment agreements help to crystallize the shared understanding between clinician and patient.
  • Special warning about opioid use with benzodiazepines: Opioid’s adverse effects increase when used concurrently with benzodiazepines, and clinicians should avoid prescribing them at the same time.
  • State prescription drug monitoring programs (PDMP): Clinicians should check state PDMPs before prescribing opioids. PDMPs should also be used to monitor patients throughout treatment to ensure they’re receiving appropriate prescriptions.
  • Note on naloxone: Clinicians should consider prescribing naloxone for all patients with an opioid prescription to use in case of overdose.

I had asked my pain doctor for a naloxone dose because I thought it would be good to have around the house where I also keep my opoids, just in case someone found them and took too many.

At the pharmacy, I was shocked to see that it cost about $300 and insurance wouldn’t help pay for it.

So that’s the condition of our medical system:

  • they say opioids are terribly dangerous, and there’s a crisis of overdoses, but
  • they make the antidote affordable only for the wealthy.

Guidelines Versus Standards: Pros and Cons

The guidelines are a resource that provides “overall guidance” to state medical and osteopathic boards in reviewing whether opioids are being used appropriately. As such, they are not a specific standard of care.

The broad nature of the guidelines has its merits and drawbacks, Dr. Twillman said.

“For example, it talks in generalities about people being on high or low doses without giving a range,” he said. “That leaves room for medical boards to set their own minimums or limits in doses, and that can be problematic.”

On the other hand, Dr. Twillman noted the flexibility built into the guidelines encourages clinicians

to take a more individualized approach to care rather than relying on set-in-stone standards that can inadvertently depersonalize the patient experience.

Anyone who understands biology knows that effective doses vary tremendously between individuals so any “standard” could become malpractice on an individual basis.

“The take-home message is that clinicians really have to do a comprehensive assessment of the patient,” Dr. Twillman said.

I thought this was a standard for ALL medical care, not just for pain. What has happened to the field of medicine where a comprehensive assessment of a patient is not considered a part of standard treatments.

This insinuates that a comprehensive assessment of a patient is no longer considered a part of standard patient treatments.

“It’s not just about what is going on with them biologically. You have to cover the multitude of factors that go into the experience of chronic pain—including depression and anxiety—to determine the most appropriate treatment.”

From Theory to Practice: Barriers to Following the Guidelines

The guidelines provide a framework to help state boards and clinicians safely and effectively use opioids to manage chronic pain. But, one big barrier exists: awareness.


Federation of State Medical Boards. Guidelines for the chronic use of opioid analgesics. Available at: https://www.fsmb.org/Media/Default/PDF/Advocacy/Opioid%20Guidelines%20As%20Adopted%20April%202017_FINAL.pdf. Accessed June 19, 2017.


4 thoughts on “Updated Opioid Guidelines for State Medical Boards 

  1. scott michaels

    so nothing was done to hrlp tjose tjat have been on high dose opioids with great success yet because kaiser and others just see the dollars they can cut you down or off without cause and reinlfict the pain that the opioids reduced greatly.

    Liked by 1 person

  2. Candi Simonis

    What these Government agencies are doing is fighting chronic pain disease patients. We use legitimate prescription medications for a disease. The crisis is that they are targeting CHRONIC PAIN PATIENTS. Chronic pain is now the epidemic. We are being caterogized and descriminated against for a medication we require to reduce our pain. No other chronic disease patient is targeted for their use of a prescription medication.
    What about the good of opioid medications. They are lifesaving medications for millions of Americans who live in constant, debilitating, chronic pain.
    Though the number of prescribed opioids are down, the overdose deaths are “reportedly, at an all time high”. So this system is not working.
    When a death does occur, there is no specific testing as to what opioid drugs attibuted to the death. Whether there were other drugs or alcohol in the system, or whether the specific “medication” was for that individual, was it illegally manufactured heroin, fentynal or carfentynal.
    The misuse of medication by legitimate chronic pain disease patients is .02-.6 %. It is use of illegal opioids and misuse of legal opioid medications that lead to abuse by citizens.
    The FDA, DEA, CDC and all other Government agencies need to go after the illegal fentynal and heroin producers and manufacturers, also, methamphetamine, cocaine and all other illegal drugs. Addicts will always have the illegal drugs and find a way to get them.
    Why is it that our physicians are no longer able to Doctor us? Why is it that these agencies can now Doctor us and practice medicine without a medical license? What has happened to Doctor/patient confidentiality. It no longer excists. Pharmacists, insurance companies and these Government agencies are now able to decide what us patients actually need when it comes to our medications. They are policing our physicians. I believe it is up to our physicians to treat us adequately and humanely with medication, so many of us desperately need, for our disease.
    This targeting is wrong! It is discrimination against legitimate chronic pain disease patients who use our MEDICATION responsibly.
    Addicts will find and use the illegal drugs of their choice. We pain disease patients are not addicts, we are PATIENTS, with incurable diseases. Medications are readily available to us for our conditions, that happens to fall into the same category as the illegal drugs.

    Liked by 1 person

  3. Emily Raven

    I think what bothers me most is that at first glance things like this seem pretty benign and “business as usual” but the problem is the doublespeak: assessing risks means “assume risk and lie about patients’ statements/outcome”



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