Opioids are no longer considered the first choice for the treatment of pain. Most of our patients come to us already on some type of opioid for many years, starting back when the medical profession thought differently about pain. A patient who has been on opioids for so long may have suffered damage to the chemistry of the brain, and may struggle in life without any medication. And so we manage them - we work hard to reduce the dose whenever possible, to stabilize the function and improve the quality of life, and to present alternatives that, if tried, hold the potential to reduce the need for opioids. It has been our experience through many patients that have been weaned actually experience less pain.

For those who take opioids, there are several things they need to know:

- We follow the CDC Guidelines for prescribing opioids.

- All patients taking opioids must sign both a pain contract and an opioid consent form.

- In accordance with the CDC Guidelines, we do not allow patients taking opioids to also take sedatives like diazepam or clonazepam.

- These benzodiazepine drugs are very dangerous when combined with opioids. If you have been on a benzodiazepine for some time, then we will wean you gently off of the drug.

- Urine Drug Testing is performed randomly but regularly.

- Prescriptions for opioids may not be obtained outside an office visit.
- For many patients, the visit frequency is every two months.

- In accordance with the CDC guidelines, patients taking high doses of opioid (expressed in Morphine Milligram Equivalents (MME)) will need to be gently and slowly weaned down to acceptable dosages. If your dose is greater than CDC guidelines, we can only prescribe for you if you allow your dose to be slowly and gently reduced.