Opioids for Chronic Noncancer Pain: The Need for Balance

In this position paper, the American Academy of Neurology reviews the rise in opioid-associated harms, the lack of evidence for long-term effectiveness, and the policy response to rising abuse and overdose. The paper includes proposals for best practices for safe opioid prescribing, including tracking pain and function; documenting all opioid sources; conducting random urine testing; screening for histories of substance abuse and depression, anxiety, or posttraumatic stress disorder; using a “patient treatment agreement”; and prescribing doses above about 120 morphine-equivalent mg/day only when the patient has “sustained meaningful” improvements in pain and function, in consultation with a pain management specialist.