CSAM Recommendations for Safe Opioid Prescribing

Version 1.0 (03/01/19)

Important Notes:

• These recommendations were initially developed by Kaiser Permanente and then modified and endorsed by Safe Med LA and on December 12, 2018 by the California Society of Addiction Medicine’s (CSAM) Committee on Opioids. They are based on recommendations and guidelines from the Centers for Disease Control and Prevention (CDC), CSAM, and other subject matter experts. 
• As with any clinical recommendations, provider judgment should govern considerations involved in high quality and evidence-based patient care. 
• Importantly, these recommendations should not be interpreted to require involuntary and/or rapid tapers, which can be more harmful than they are beneficial by putting patients at risk for poor outcomes such as medical and/or psychiatric decompensation, relapse or illicit drug use, overdose, and self-harm. Tapering decisions must be made based on the individual circumstances of each case, with careful consideration of the risks and benefits. 
• Prescribers need to be aware of additional local, state, and federal laws and regulations involving opioid prescribing that may supersede these recommendations. 
• For any prescribing outside of these recommendations, it is highly advised that the reason(s) be documented in the patient’s medical record. 
• These recommendations do NOT pertain to palliative care, end-of-life (hospice), or active cancer treatment.