FP essentials
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Opioids are not first-line therapy for chronic noncancer pain or nonsevere acute pain. Overall, evidence does not show that opioids are superior to nonopioid interventions, and opioids pose a high risk of harm. A trial of opioid therapy may be considered for patients who have persistent severe pain plus functional limitations despite adherence to multiple appropriate nonopioid therapies. ⋯ Caution is indicated when 50 or more morphine milligram equivalents (MME)/day of opioids are prescribed, and dosages of 90 MME/day or more should be avoided. Naloxone should be provided for patients at high risk of overdose. If harms outweigh benefits, opioids should be tapered and discontinued.