POLICY UPDATE: Patients who are treated with opioid pain medications at Pain Care Specialists of Oregon will sign an agreement with Pain Care Specialists of Oregon. PCSO will provide no more than a 14 day supply of any opioid medication. All patients are required to be physically present at the clinic to obtain a script that, ideally, is of a lower dose of opioid medication every 14 days or less. All patients with moderate to high use of opioid medications, and while taking an opioid medication prescribed by PCSO, will submit a urine drug screen with automatic confirmation testing at each prescription refill. This policy will amount to a total of two (2) urine drug screens within a 30 day period. The patient will also be subject to random cognitive testing, pharmacy reports and pill counts. These guidelines will help ensure that medications are being used in an appropriate and safe manner.

Opioid pain medications (also known as opiate or narcotic pain medications) are a potentially valuable source of relief for those suffering from chronic pain. They are also dangerous substances that carry the risk of bowel obstruction, liver failure, kidney failure, cardiac arrhythmia, respiratory depression and death. These medications are some of the most potentially addictive substances. Use of these medications carries risk of dependence, tolerance, withdrawals, increased pain with chronic use, depression and anxiety. The use of these substances should not be taken lightly.

Pain Care Specialists of Oregon providers will use a combination of factors to determine if a patient is a good candidate for opioid therapy. These factors include the patient’s medical, surgical and family history. The patient will be given assessments such as the Opioid Risk Tool and the Oswestry Disability Index to make sure that the opioid therapy is appropriately treating the patient’s pain.

Mixing opioid pain medications with other controlled substances can be extremely dangerous. Substances such as benzodiazepines, medical marijuana, alcohol and Soma/carisoprodol can increase the risk of complications or death in an opioid patient by up to 100%. Pain Care Specialists of Oregon may limit or discontinue opioid therapy in patient’s taking benzodiazepines or Soma/carisoprodol.

PLEASE NOTE: Marijuana is especially dangerous when mixed with opioid pain medications. Pain Care Specialists of Oregon providers will not prescribe opioid pain medications to patients using marijuana in any form whether recreationally or medically.

Patients who are prescribed opioid medications that exceed the following dosages are considered to be “high risk” and will be monitored with more care and caution:

Medication -> Dose -> Within:

Morphine -> 120mg -> 24 hrs
Hydrocodone -> 120mg -> 24 hrs
Oxycodone -> 80mg -> 24 hrs
Hydromophone -> 30mg -> 24 hrs
Fentanyl patch -> 75mcg -> 1 hr
Oxymorphone -> 40mg -> 24 hrs
Nucynta -> 300mg -> 24 hrs
Methadone -> 30mg -> 24 hrs

Opioid medications will be discontinued if the patient is found to be diverting opioids, using the medication inappropriately or if the patient is not showing functional improvement in their condition. Opioid therapy can be discontinued at the discretion of Pain Care Specialists of Oregon providers at any time.

Additional Resources:

Pain Care Medication Options:


Anticonvulsants/Nerve Stabilizers

Anti-depressants for Pain Control

Anti-nausea Medications


Blood Thinners


Muscle Relaxants

NSAIDS (Non-steroidal Anti-Inflamatory Drugs)



Migraine Medications

Treating Constipation

Tricyclic Antidepressants

Diabetes Medication Protocol


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