Update 2026
medical conditions that may pose serious and life-threatening risks with opioid
use - - answer-Sleep-disordered breathing such as sleep apnea
-Pregnancy
-Renal or hepatic insufficiency
-Age >= 65
-Certain mental health conditions
-SUD
-Previous nonfatal overdose
Titrating Opioids to >=50 MME/day - - answerWhen considering increasing
dosage to >=50 MME/day:
-Carefully reassess individual benefits and risks for such a dosage increase,
including whether opioids are meeting the patient's treatment goals
-Increase follow-up intervals to every 1 to 4 weeks
-Consider offering naloxone and overdose prevention education to both patient
and the patient's household members
,Avoid Titrating Opioids to ________ - - answer>=90 MME/Day
Providers should reevaluate benefits and harms with patients within _______
weeks of starting opioid therapy or a dose escalation. - - answer1 to 4 weeks
-provides an opportunity to minimize risks of long-term opioid use by
discontinuing opioids among patients not receiving a clear benefit from these
medications.
Providers should reevaluate benefits and harms of continued therapy with
patients every ________ or more frequently. - - answer3 months
Initiating ER/LA Opioids - - answer-risks for opioid overdose are greatest during
the first 3-7 days after opioid initiation or an increase in dosage, particularly when
ER/LA opioids are initiated
• also includes methadone & transdermal fentanyl
-Follow-up within 3 days is appropriate when initiating or increasing the dosage of
methadone
-Follow-up within 1 week is appropriate when initiating or increasing the dosage
of other ER/LA opioids
If the patient's dosage is increased to 5/325 mg oxycodone/acetaminophen QID
PRN, what would the daily maximum MME be, assuming the patient takes the full
four doses each day? Select the best - answer.
15 MME/day
50 MME/day
, 30 MME/day
20 MME/day - - answer30 MME/day
Rationale:
5 mg oxycodone QID is 20 mg/day. When you multiply 20 by the conversion factor
of 1.5, the result is 30 MME/day.
A follow-up visit within two weeks is appropriate for which of the following
reasons? Select all that apply.
a. Providers should reevaluate benefits and harms with patients within 1 to 4
weeks of starting opioid therapy or a dose escalation
b. This patient's new dosage is above the 50 MME/day threshold and therefore
should be closely monitored
c. It is less likely that continued opioid therapy will be effective for this patient if
she is not receiving relief 1 month after starting an opioid
d. Reassessment of pain and function within 1 month of initiating opioids provides
an opportunity to minimize risks of long-term opioid use - - answera c d
High-Dosing Risks - - answeradd risk without clear benefit. Furthermore, benefits
of high-dose opioids for chronic pain have not been established. A randomized
controlled trial found no difference in pain or function between liberal dose
escalation and maintenance of current opioid dosage
-increase risk of serious harm, including fatal and nonfatal overdose
Dosage and Overdose Risk - - answer-Dosages >=50 MME/day increase the risk of
overdose by at least two-fold compared with dosages 20 MME/day.