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 their opioid agonist providers aware of the therapy.

Specify “to be dispensed with methadone or buprenorphine”.  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 – they will likely have a significantly higher tolerance to opioids than the opioid naive patient. A reasonable starting point is twice the amount of analgesic for an opioid naive patient in the same circumstance – for example 10mg of oxycodone q4h instead of 5mg. This is a group of patients that can access illicit opioids if their analgesic Rx is subtherapeutic. Being exposed to the triggers involved in procurement of illicit opioids is a much higher risk to their recovery than using prescribed opioids to treat their  pain. They are less likely to use illicit opioids if their pain is controlled. 
Provide a Rx for adjuvant medication if appropriate.