Bradley attorney Jason Mehta was featured in Practical Pain Management in a response to a letter to the editor from a board-certified anesthesiologist on the 90 MME a day ceiling.
The federal government has repeatedly stated its views that, as a general guideline, practitioners should not prescribe more than 90 MME/day. These guidelines can be found, for example, on the CDC website. It is important to note that these are just guidelines and not bright-line rules.
As a general matter, when opioids are started, clinicians should prescribe the lowest effective dosage. It is a best practice to use caution when prescribing opioids at any dosage and practitioners would be well-advised to carefully reassess evidence of individual benefits and risks when prescribing opioids, particularly where dosage is 50 MME/day.
Other best practices include considering offering naloxone when a patient is at risk for opioid overdose, reviewing patients’ prescription drug monitoring program data, and using urine drug toxicology tests to confirm patients’ compliance. As with most things, these suggestions are just that – suggestions that ultimately will need to be modified to a physician’s individual needs.
The complete article, “Letters to the Editor: 90 MME/day Ceiling; Ehlers-Danlos Redefining Pain,” appeared in the July/August 2018 issue of Practical Pain Management.