High Risk Demographic Groups

Risk Factors: congestive heart failure and obesity Best Practices: Mild Sleep-Disordered Breathing: - careful monitoring - cautious dose titration Moderate-Severe Sleep-Disordered Breathing: - avoid prescribing opioids whenever possible​ to minimize risks for opioid overdose

Risk Factors: - neonatal opioid withdrawal syndrome - neonatal toxicity and death have been reported in breast-feeding infants whose mothers are taking codeine - stillbirth - poor fetal growth - pre-term delivery - birth defects Best Practices: - Clinicians and patients should carefully weigh risks and benefits when making decisions about whether to initiate opioid therapy for chronic pain during pregnancy - Before initiating opioid therapy for chronic pain for reproductive-age women, clinicians should discuss family planning and how long-term opioid use might affect any future pregnancy. - Codeine should be avoided whenever possible among mothers who are breast feeding and, if used, should be limited to the lowest possible dose and to a 4-day supply Pregnant women already receiving opioids: - Clinicians should access appropriate expertise if considering tapering opioids because of possible risk to the pregnant patient and to the fetus if the patient goes into withdrawal Pregnant women with opioid use disorder: - Medication-assisted therapy with buprenorphine or methadone has been associated with improved maternal outcomes and should be offered Caring for pregnant women receiving opioids for pain or receiving buprenorphine or methadone for opioid use disorder: - Clinicians should arrange for delivery at a facility prepared to monitor, evaluate for, and treat neonatal opioid withdrawal syndrome. - In instances when travel to such a facility would present an undue burden on the pregnant woman, it is appropriate to deliver locally, monitor and evaluate the newborn for neonatal opioid withdrawal syndrome, and transfer the newborn for additional treatment if needed.

Clinicians should use additional caution and increased monitoring (see Recommendation 7) to minimize risks of opioids prescribed for patients with renal or hepatic insufficiency, given their decreased ability to process and excrete drugs, susceptibility to accumulation of opioids, and reduced therapeutic window between safe dosages and dosages associated with respiratory depression and overdose (contextual evidence review; see Recommendations 4, 5, and 7).

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Collapsible text is perfect for longer content like paragraphs and descriptions. It’s a great way to give people more information while keeping your layout clean. Link your text to anything, including an external website or a different page. You can set your text box to expand and collapse when people click, so they can read more or less info.

Collapsible text is perfect for longer content like paragraphs and descriptions. It’s a great way to give people more information while keeping your layout clean. Link your text to anything, including an external website or a different page. You can set your text box to expand and collapse when people click, so they can read more or less info.