Opioid Safety Starts With a Conversation at the Pharmacy Counter

An opioid refill offers an opportunity to ask whether treatment is helping a patient live better—and whether anything has changed since the last prescription. A new sedating medication or difficulty staying awake can change the safety conversation even when the opioid dose remains the same. Opioid management was among the educational topics highlighted for ASRA Pain Medicine’s 25th Annual Pain Medicine Meeting, held November 5 through 7, 2026, in Tampa, Florida. For pharmacists, that focus provides a timely opportunity to examine how safety measures translate into everyday patient care.¹

Start With the Patient’s Treatment Goals

A useful conversation goes beyond asking patients to rate their pain. Asking what treatment allows them to do gives the care team a practical way to assess benefit. Being able to walk through a grocery store, for example, can make a treatment goal more meaningful than a pain score alone.

The CDC’s 2022 opioid prescribing guideline emphasizes individualized decisions and patient involvement. Nonopioid therapies are preferred for subacute and chronic pain, and opioid treatment should have realistic goals for pain and function. These recommendations apply to adult outpatients and exclude pain management related to sickle cell disease or cancer, as well as palliative and end-of-life care.²

That scope matters when counseling patients whose prescriptions look similar but serve different clinical needs. Pharmacists can clarify the indication and communicate unresolved questions to the prescriber before suggesting changes.

Revisit Risk When the Medication List Changes

In July 2025, the FDA required opioid labeling updates addressing risks associated with long-term use. The agency emphasized that serious harms persist throughout treatment and that overdose risk increases with higher doses.³

Medication reconciliation can bring those warnings into practice. Pharmacists should identify benzodiazepines and other central nervous system depressants, including gabapentinoids, and communicate concerns about combined exposure. Counseling should explain respiratory depression in recognizable terms, including severe sleepiness or slowed breathing.³

The discussion should also cover what patients take outside the prescription list. Asking about alcohol and nonprescribed substances without judgment can help uncover risks that a dispensing record cannot show.² A clear explanation of why these questions matter gives patients a reason to share information.

Make Monitoring a Conversation

Prescription drug monitoring program (PDMP) information can reveal overlapping opioid prescriptions or combinations associated with overdose risk; however, an unexpected entry requires clarification with the patient and coordination among clinicians. CDC guidance advises confirming PDMP findings with patients and discussing safety concerns with other prescribers. It also advises against dismissing patients from care based on PDMP information. Applying checks consistently, when feasible, helps reduce bias in how monitoring is used.⁴

For pharmacists, the practical next step is to explain the concern: which medications overlap, why that combination matters, and what needs clarification. Documenting the discussion can help the next clinician understand the issue and the response.

Turn Overdose Counseling Into a Usable Plan

The FDA recommends discussing opioid overdose reversal agents, including naloxone and nalmefene, with every patient prescribed an opioid pain medicine. Several naloxone nasal sprays are available over the counter.³

Pharmacists can use that conversation to establish whether a reversal medicine is available at home and whether someone knows where to find it. Patients and caregivers should understand that suspected respiratory depression requires immediate emergency help. Secure opioid storage and prompt disposal of unused medication also deserve attention.³ Presenting overdose preparedness as a routine part of medication counseling can make the discussion easier to begin.

Keep Patients Supported When Treatment Changes

Follow-up should examine whether benefits continue to outweigh risks. The CDC recommends reassessment at least every 3 months for chronic opioid therapy, with more frequent review when the clinical situation warrants it.⁵

If benefits outweigh the risks, health care professionals should optimize nonopioid therapies while continuing opioids. If risks outweigh the benefits, treatment changes should be made collaboratively, with gradual tapering when appropriate. Unless there are signs of a life-threatening problem, opioids should not be stopped abruptly.⁵

Pharmacists can help patients understand the agreed plan and relay concerns about worsening pain or withdrawal to the prescriber. A refill, monitoring result, or dose change becomes more useful when it leads to a clear next step that the patient understands.

REFERENCES

1. ASRA Pain Medicine. Pain medicine meeting. Accessed November 12, 2026. https://asra.com/events-education/pain-medicine-meeting

2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(No. RR-3):1–95. doi:10.15585/mmwr.rr7103a1

3. FDA. FDA is requiring opioid pain medicine manufacturers to update prescribing information regarding long-term use. July 31, 2025. Accessed November 12, 2026. https://www.fda.gov/drugs/drug-safety-communications/fda-requiring-opioid-pain-medicine-manufacturers-update-prescribing-information-regarding-long-term

4. Prescription drug monitoring programs (PDMPs). CDC. May 6, 2024. Accessed November 12, 2026. https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/prescription-drug-monitoring-programs.html

5. Continuing opioid therapy. CDC. May 7, 2024. Accessed November 12, 2026. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/continuing-opioid-therapy.htm