Minimize analgesic abuse potential:
Consider prescribing discharge opioid analgesics with the following modifiers:
• Fax the Rx to the pharmacy they use for their maintenance medication. This prevents the chance of Rx forgery and helps keep opioid agonist providers aware of the therapy.
• Specify “to be dispensed with methadone or suboxone”. The patient will then get more or less analgesics “in hand” depending on their stability. For example a patient with full carries will get 6 days of opioid analgesics to take home whereas a patient with no carries will get their opioids every day when the come to get their maintenance opioids.
• Use a shorter duration of therapy – perhaps 1 week assuming they will be in a condition to get to BMC within this time frame. BMC can take over at that point.
• Prescribe an appropriate dose of analgesic opioids otherwise there is a risk they may find another way to treat their pain – this has implications with respect to their recovery. This is a group of patients that can easily access illicit opioids if their analgesic Rx is subtherapeutic. They are less likely to abuse opioids if their pain is controlled. They will likely have a significantly higher tolerance to opioids than the opiod naive patient and may require 30-100% more opioids for effective analgesia.
• Provide a Rx for adjuvant medication if appropriate.