Prescribing Safety — PDMP, Tapering, Safe Storage
Module 6 of 11 · 45 min
PDMP use, safe opioid prescribing, dose tapering protocols, safe storage + disposal counseling.
Learning objectives
- •Use the state PDMP appropriately before prescribing controlled substances
- •Apply CDC opioid prescribing guidelines
- •Initiate + execute safe opioid taper
- •Counsel patients on safe storage + disposal
PDMP — Prescription Drug Monitoring Program
State databases of all controlled substance prescriptions filled. CRNAs MUST query PDMP before prescribing schedule II (and often III-IV) in 49 states. Look for: multiple prescribers, multiple pharmacies, escalating MMEs, concurrent benzodiazepine, early refills. Review with patient — opens conversation. Some EHRs auto-pull PDMP; others require separate login. Document PDMP review.
CDC opioid prescribing guidelines (2022 update)
Start low, go slow. Immediate-release first; reserve ER for chronic, tolerant patients. Avoid concurrent benzodiazepines (synergistic respiratory depression). Re-evaluate at 1 week + 4 weeks. Continue only if function improves. Maximum acute pain: 3-7 day prescription unless specific indication. Avoid dose escalation > 50 MME/day without specialist. Counsel on overdose + addiction risk at every visit.
Tapering
Indicated when: no functional benefit, side effects > benefits, patient request, MAT initiation, OUD development. Slow taper: 5-10% reduction every 2-4 weeks, slower toward end. Faster tapers (> 10% per week) are associated with worsening pain, mental health crisis, illicit substitution, suicide. Provide non-opioid alternatives (NSAIDs, acetaminophen, gabapentinoids, SNRIs, PT, behavioral). NEVER force-taper as discipline.
Safe storage + disposal
Lock medications. Don't store in bathroom (heat + humidity degrade). Never share. Disposal: DEA Take-Back Days (twice yearly), pharmacy take-back kiosks, FDA-approved deactivation pouches (DisposeRx), or flush-list controlled substances per FDA flush list. Counsel ALL patients receiving opioids — adolescents in household are #1 source of pediatric opioid exposure.
References
- · CDC Clinical Practice Guideline for Prescribing Opioids 2022
- · DEA Diversion Control