MGH rolls out new opioid prescription guidelines for doctors

BOSTON — Massachusetts General Hospital is rolling out new guidelines for its doctors on how and when they should prescribe opioids.

The guidelines mark a change from what's been described as a more "flexible" approach to doling out opioid medication.

Dr. Sarah Wakeman told FOX25 that the story of opioid crisis in Massachusetts was written out on countless prescription pads.

"In the 90's we saw doctors prescribe more and more of these medications.  We'd been told that they were not addictive when used to treat pain...Which was actually not true, it turned out," she said.

Often, patients would be sent home with far more of the drugs than was necessary.

"It's the person who got a surgical procedure and went home with 90 tablets of a pill that they really only needed a couple of," she said.

That left drugs that could be shared or abused, often with a "health halo" for patients who believed they were safe, because they were prescribed. Now, five people die every day in Massachusetts from opioid overdoses.

MGH's new guidelines for their doctors are trying to alleviate the opioid crisis. They tells doctors how to walk the line between doling out too many drugs and being able to relieve pain compassionately.

The overarching goal, as first reported on FOX25 News at 5, is to use opioids as a last resort, for the shortest amount of time, in the smallest possible dosage.

• Prescribe opioids only for severe pain and when other treatments are unlikely to help
• If opioids are necessary, they should be prescribed at the lowest effective dose and for a limited period
• For acute pain unrelated to surgery, major trauma, cancer, or palliative care, prescribe no more than a 7-day supply
• Long-acting or extended-release opioids should not be used for the treatment of acute pain
• Check the Prescription Monitoring Program (PMP) prior to every prescription (see side bar on page 2)
• Document history, physical exam, diagnosis, plan, and "partial fill acceptable"
• Communicate with any other active prescribers
• Use a risk tool to screen patients for risk of opioid misuse and personal history of
• substance use disorder
• Counsel patients on the risks, including addiction, overdose, and death
• Set patient expectations that pain medicines help manage, but not resolve pain
• Offer addiction treatment to any patient identified as having a substance use disorder

There are separate guidelines for chronic pain, acute pain, and for pediatric patients.

Dr. Wakeman told FOX25 News they'd also like to see more people with the overdose-reversing drug Narcan, readily available.

"We believe that should be in people's medicine cabinets as well. That this can be a lifesaver.  And people can unintentionally overdose on these medications, even for pain treatment," she said.

The hospital is sharing those guidelines with other agencies and hospitals, hoping that it could have a ripple effect on the health care industry as a whole.

Cox Media Group