Respond to suspicion of opioid misuse or diversion by collecting more information and discussing with the patient.

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Sometimes there are very few symptoms. A blood test from your doctor will confirm whether or not you have a thyroid disorder.

Disposal. Advise patients how to dispose of unused opioid medications safely and securely. Many options for disposal exist. Having unneeded opioids in the home is a vulnerability for patients and their families.

Sublingual buprenorphine (Suboxone, Subutex and generic) may be prescribed off-label for pain with a regular DEA number. Sublingual buprenorphine has an evolving role, particularly in patients already treated with high dose opioid therapy who continue to complain of uncontrolled pain, and who may or may not have opioid use disorder.

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Nociceptive pain is caused by tissue damage due to injury or inflammation, rather than harm to the central or peripheral nervous system. This is the primary type of pain involved in patients with arthritis, musculoskeletal inflammatory disorders (tendinosis, bursitis), or structural spine pain.

Understand regulations for prescribing controlled substances. Know state and federal regulations regarding controlled substance prescriptions. Key features include:

Advantages of buprenorphine include its effectiveness, and lack of development of tolerance to it. As a Schedule III drug, it may be written with refills for up to seis months. Disadvantages include occasional problems with rash from transdermal patch use, and greater expense.

Short-term opioid therapy may be appropriate for acute pain management to allow for rehabilitation. For chronic pain, opioid therapy is beneficial if it allows a return to function or maintenance of function with minimal adverse effects.

Assess the benefits and risks to determine whether an opioid will improve overall chronic pain management.

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Get a medical evaluation. Before you take sleeping pills, see your health care provider for a thorough exam. Often your provider may be able to find specific causes for your insomnia.