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Brigham Health Acute Opioid Use Guidelines
Brigham Health Chronic Opioid Use Guidelines
BWH Pharmacy Medication Management Guideline: Perioperative Management of Buprenorphine
Dana Farber Cancer Institute/Brigham & Women's Hospital Pain Management Tables and Guidelines (“Pink Book”)
Chronic Non-Cancer Pain Physician-Pharmacist Collaborative Drug Therapy Management (CDTM) Agreement
Brigham Health Acute Opioid Use Guidelines
This document offers a unified approach to guide physicians in the appropriate initiation of opioids for acute non-malignant pain. Acute pain is defined as pain that is provoked by a specific disease or injury, or occurs subsequent to surgery, and is self-limited, lasting no longer than 90 days. The document offers guidance on pain assessment and reassessment, non-opioid alternatives, risk assessment, opioid prescribing, patient counseling and discharge planning.
Brigham Health Chronic Opioid Use Guidelines
This document offers support to providers in delivering care to patients suffering from chronic, non-malignant pain, while reducing the number of people inappropriately prescribed opioids and those continued on opioids who are not achieving functional goals, have serious side effects, or exhibit concerning behavior. These guidelines recognize that there are some patients who may benefit from chronic opioid therapy (i.e., prescribed for greater than 90 days) as a component of their management. These guidelines do NOT apply to patients with active cancer and malignancy associated pain or patients receiving hospice or palliative care. Before opioids are prescribed for chronic non-malignant pain, a diagnosis must be established, the patient must be screened for risk of misuse (including checking the Prescription Monitoring Program), and a plan of care documented.
BWH Pharmacy Medication Management Guideline: Perioperative Management of Buprenorphine
The objective of this guideline is to address the potential difficulty in achieving analgesia for patients who present for elective and emergent surgery and are taking buprenorphine and to offer guidance to achieve appropriate perioperative pain management.
Dana Farber Cancer Institute/Brigham & Women's Hospital Pain Management Tables and Guidelines (“Pink Book”)
This detailed, multidisciplinary document provides recommendations on pain assessment and management. Information on opioids includes pharmacology; equianalgesic dosing; guidance on use of methadone, fentanyl and PCAs; management of side effects; guidance for weaning; inpatient treatment of opioid-induced respiratory depression and available formulations. Other information presented includes dosing, recommended use and available formulations of all classes of adjuvant analgesic agents (e.g., NSAIDS, anti-convulsants, anti-depressants and muscle relaxants).
Chronic Non-Cancer Pain Physician-Pharmacist Collaborative Drug Therapy Management (CDTM) Agreement
This guideline defines the disease states and scope of practice for Clinical Pharmacists in collaboration with a Supervising Chronic Pain Physician.
Equianalgesic Opioid Dosing Table and Conversion Example
This document provides a table of approximate equianalgesic doses (i.e., doses, in an opioid-naïve patient, that will provide a similar analgesic effect) for the most commonly used opioids. It also goes through a step-by-step example of how to do a conversion from one opioid to another, taking into account incomplete cross-tolerance.
Methadone Conversion Guideline
This document provides guidance on converting FROM another opioid TO methadone using an equianalgesic dosing table that takes into account methadone's dose-dependent potency. It also goes through a step-by-step example of how to do a conversion.
Online Opioid Conversion Program - single agent
This external program aides you in converting from one opioid to another (or one route to another) by performing the calculation for you after you enter the present daily opioid dose, the opioid you wish to convert to and the percent of incomplete cross tolerance you wish to use.
Online Opioid Conversion Program - multiple agents
This external program aides you in converting from a few different opioids to a single agent by performing the calculation for you after you enter the present daily opioid doses, the opioid you wish to convert to and the percent of incomplete cross tolerance you wish to use.