CDC 2016 has put out a checklist for opioid use. It does not emphasize much on use of injection, manual medicine and other alternative techniques but does give some guidelines.
MMWR Recomm Rep. 2016 Mar 18;65(1):1-49. doi: 10.15585/mmwr.rr6501e1.
CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.
Dowell D(1), Haegerich TM, Chou R.
http://stacks.cdc.gov/view/cdc/38025
Recommendations are not long so I have cut and pasted:
Checklist for prescribing opioids for chronic pain
For primary care providers treating adults (18+) with chronic pain ≥ 3 months, excluding cancer, palliative, and end-of-life care
CHECKLIST
here in word format: Checklist for prescribing opioids for chronic pain
When CONSIDERING long-term opioid therapy
- Set realistic goals for pain and function based on diagnosis (eg, walk around the block).
- Check that non-opioid therapies tried and optimized.
- Discuss benefits and risks (eg, addiction, overdose) with patient.
- Evaluate risk of harm or misuse.
- Discuss risk factors with patient.
- Check prescription drug monitoring program (PDMP) data.
- Check urine drug screen.
- Set criteria for stopping or continuing opioids.
- Assess baseline pain and function (eg, PEG scale).
- Schedule initial reassessment within 1-4 weeks.
- Prescribe short-acting opioids using lowest dosage on product labeling; match duration to scheduled reassessment.
If RENEWING without patient visit
- Check that return visit is scheduled ≤ 3 months from last visit.
- When REASSESSING at return visit
- Continue opioids only after confirming clinically meaningful improvements in pain and function without significant risks or harm.
- Assess pain and function (eg, PEG); compare results to baseline.
- Evaluate risk of harm or misuse:
- Observe patient for signs of over-sedation or overdose risk. – If yes: Taper dose.
- Check PDMP.
- Check for opioid use disorder if indicated (eg, difficulty controlling use). – If yes: Refer for treatment.
- Check that non-opioid therapies optimized.
- Determine whether to continue, adjust, taper, or stop opioids.
Calculate opioid dosage morphine milligram equivalent (MME).
- If ≥ 50 MME /day total (≥ 50 mg hydrocodone; ≥ 33 mg oxycodone), increase frequency of follow-up; consider offering naloxone.
- Avoid ≥ 90 MME /day total (≥ 90 mg hydrocodone; ≥ 60 mg oxycodone),or carefully justify; consider specialist referral.
- Schedule reassessment at regular intervals (≤ 3 months)
Comment – could use with diabetics, if pills don’t get control because they are to uncontrolled on eating, I’m going to consider stopping all their meds… – no, just kidding – but point be taken. They have an emphasis on no comorbid bensodiazepine use – a problem I have with some bipolar cases that uses benzos to help control their agitated states while waiting for atypicals to work and with some body armoured rigid pain cases. None the less, now that the combined used can increase risk of death by up to 15 times, I am working hard to get them all off them. They make a point of looking for sleep apnea. Much of guidelines could be used in Cannabinoid use and I will see re this.