Toxicology Group Takes Position on Opioid Prescribing

JANUARY 24, 2016
Amid the opioid abuse crisis, American clinicians are struggling to strike a balance between providing appropriate pain management and limiting risk for abuse, all while meeting regulatory standards for patient satisfaction. 

At the organizational level, some groups are beginning to provide best practices or position statements to curtail the use of opioids.

The American College of Medical Toxicology (ACMT) recently issued the following position statements on opioid prescribing:

Position 1: Acetaminophen-Opioid Combination Products
The ACMT recommends that the risks and benefits be considered for both acetaminophen toxicity and the opioid contained in the formulation.

As many pharmacists are aware, the use of multiple products co-formulated with acetaminophen can contribute to chronic exposure of 3 g to 4 g of acetaminophen daily, which can increase the risk of hepatotoxicity. Separating the dosage form into its individual components may be a reasonable solution, although the ACMT does not go as far as to suggest this practice.

Position 2: Daily Opioid Dosing Limits
The ACMT urges caution when prescribing daily opioid doses exceeding 50 mg of morphine equivalents.

This daily dosing limit is equivalent to hydromorphone 12.5 mg/day, oxycodone 33.3 mg/day, or oxymorphone 16.7 mg/day

Position 3: Abuse-Deterrent Formulation and Tamper-Resistant Packaging
The ACMT urges clinicians to understand that abuse-deterrent formulation or tamper-resistant packaging does not remove the risk for opioid abuse. These measures deter snorting or injecting certain products; however, a large proportion of opioid abuse involves oral ingestion. 

Reference
The American College of Medical Toxicology. Safety issues regarding prescription opioids. J Med Toxicol. 5 Jan 2016 [Epub ahead of print.]

Craig Cocchio, PharmD
Craig Cocchio, PharmD
Craig Cocchio, PharmD, BCPS, is an Emergency Medicine Clinical Pharmacist at Trinity Mother Frances Hospital in Tyler, Texas. Follow on Twitter @iEMPharmD and on his blog at empharmd.blogspot.com
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