OME limits

[tmvguy03]

There certainly is no “one size fits all” treatment model in pain, but do you (or your clinic) impose a hard and fast OME limit?

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[painfree23]

Always ( unless active cancer)

 

[Ducttape]

yes, except for Legacy patients at the start.

they are tapered down to 90 MED over extended period of time, or referred to addiction (if they have dx of opioid use disorder) or referred back to the prescriber.

 

[Ferrismonk]

Yes. Virtually all patients, new or established, weaned down to at least 90MMED. I don't raise over 50MMED.

 

[emd123]

There certainly is no “one size fits all” treatment model in pain, but do you (or your clinic) impose a hard and fast OME limit?

90 mg, morphine equivalent dose, max. Hard ceiling unless cancer or palliative/end-of-life. Yes, some will argue the CDC guidelines are only for Primary Care and a "suggestion" not and absolute limit, and that some people need > 90 MED and won't be harmed by it, and I cannot say they're wrong. But as a risk reduction measure, I don't go over it. I'm glad to let someone else be the "Over 90 MED guy." There's just too damn many ODs and too much hysteria surrounding anything that is perceived as out of the norm, for me to be that guy.

For patients not on opiates, I don't start them. If on them, appropriate and 90 MED or lower, I don't dose escalate them, no matter how low. If the Fed say next year 60 MED is better, everyone gets lowered to 60. They are the only reason we're allowed to prescribe, so whatever they say, goes, for better or for worse. I see no other rational path.

 

[geauxg8rs]

I agree on the cdc gl are supposed to be for pcps it they apply it to us too. I get reports on my prescribing and nowhere is there a section for cancer patients. So if they are on >90 MED, they show up as high dose on my report. Makes no difference if they are a sad case of someone with horrible pain from cancer or if they are a 25 yo with fibromyalgia who needs their high dose opioids.