VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain Question 5 6 Interventions Short-acting opioids • Codeine • Fentanyl • Hydrocodone (only in combination with acetaminophen and ibuprofen) • Hydromorphone • Morphine sulfate (tablet/liquid) • Oxycodone (alone or in combination with acetaminophen, ibuprofen, or aspirin) • Oxymorphone • Tramadol Long-acting/ER opioids • Buprenorphine transdermal system • Fentanyl transdermal system • Hydrocodone bitartrate ER capsules/tablets • Hydromorphone hydrochloride ER tablets • Methadone hydrochloride tablets • Morphine sulfate and naltrexone ER capsules • Morphine sulfate ER capsules/tablets • Oxycodone hydrochloride and naloxone hydrochloride ER tablets • Oxycodone hydrochloride ER tablets • Oxymorphone hydrochloride ER tablets • Tapentadol ER oral tablets • Transdermal, buccal, sublingual, or pumps See main list of opioids. • Abuse deterrent formulations • Buprenorphine/Naloxone • Morphine/Naltrexone • OROS hydromorphone (Osmotic ER Oral delivery System) • Oxycodone Controlled Release • Oxymorphone • Additional medications • Tramadol and other dual-mechanism opioids • Buprenorphine • Methadone Opioid therapy plus other psychoactive medications such as CNS depressants/antidepressants, nonopioid analgesics, benzodiazepines, stimulants, muscle relaxers, medical marijuana, Z-drugs (e.g., Zolpidem [Ambien], Eszopiclone [Lunesta], Zalepion [Sonata]), and over-the-counter sleep medications (e.g., diphenhydramine hydrochloride or doxylamine succinate) February 2017 Page 108 of 192
VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain Question Interventions Naloxone rescue with one form of naloxone Informed consent Use of written informed consent (previously called contracts) Risk assessment instruments Opioid management plans Patient education Urine drug testing (UDT) Prescription drug monitoring program (PDMP) Monitoring instruments More frequent monitoring 7 Pill counts Use of abuse–deterrent formulations Diversion prevention interventions (e.g., properly securing drugs, medication take back programs, public health education) Pharmacogenetic testing Random call-backs Compliance with other therapies Case management Periodic check of state databases Needle exchange programs Treatment with at least one of the following: • Buprenorphine (with or without naloxone) • Methadone • Injectable/oral naltrexone • Medical Management 8 • Contingency Management • Individual Drug Counseling • Motivational interviewing • Motivational Enhancement Therapy • Other motivational approaches 9 One tapering strategy or schedule c. Comparator(s) Table E-3 lists the comparators of interest to this systematic review. The comparators are listed by the KQ they address. February 2017 Page 109 of 192
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VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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