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A review of medical groups’ guidelines on prescribing opioids for chronic pain finds most of the organizations are in are agreement, Reuters reports.

“There is widespread agreement about some basic ways of mitigating the risks associated with prescribing opioids for chronic pain,” said lead researcher Dr. Teryl Nuckols at the David Geffen School of Medicine at the University of California, Los Angeles.

Nuckols reviewed recommendations for doctors about prescribing opioids to patients with non-cancer pain lasting for more than three months. Most of the guidelines recommend doctors not prescribe doses greater than 90 to 200 milligrams of “morphine equivalents” daily, and that they have additional knowledge to prescribe methadone.

The guidelines agreed doctors should increase dosages slowly, and monitor patients for side effects when they first prescribe opioids. They advise reducing doses by at least 25 to 50 percent when switching opioids. The guidelines also recommend opioid risk assessment tools, written treatment agreements and urine drug testing to help manage the risk of overdose and misuse.

The findings are published in the Annals of Internal Medicine.

The study did not address how closely doctors are following the guidelines, the article notes. “Unfortunately, guidelines are not followed as often as they should be,” Nuckols said.

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