As pharmacists we know the benefits and dangers of opioids. One of the dangers is potential overdose and this is most likely to occur in those who are not opioid tolerant and receive too high of a dose.
First it is important to understand the definition of opioid tolerance. Well according to the FDA a person is opioid tolerant if for AT LEAST 1 WEEK he or she has received:
- Oral morphine 60 mg/day
- Transdermal fentanyl 25 mcg/hour
- Oral oxycodone 30 mg/day
- Oral hydromorphone 8 mg/day
- Oral oxymorphone 25 mg/day; or an equianalgesic dose of any other opioid
If a patient comes to the pharmacy and they have not received opioids before and they have a script for a 50mcg patch of fentanyl, DO NOT fill it! Taking such a dose of fentanyl and being opioid-naïve puts a patient at high risk of overdose that could be blamed on you.
In general, it is important to always remember context when evaluating an opioid prescription and any prescription for that matter!
Here is a lovely table that shows on overview of different medications that can be considered for chronic pain management.
Kgrant