To Infinity and Beyond: Safe and Effective Opioid Titration Strategies

Author: Mary Lynn McPherson

Opioids are the most powerful tool we have in our arsenal for the management of moderate to severe pain, yet great care and attention to detail in dosing is necessary to prevent patient suffering and death. This presentation is a "boots on the ground" approach to selecting, dosing, titrating, and converting bolus doses and basal infusions of opioids. Inappropriate determining and titrating basal infusion doses of opioids, especially for patients with an advanced illness, is a leading cause of opioid induced death. Practitioners often write inappropriate orders such as "titrate to comfort" with no regard for the pharmacokinetic parameters of specific opioids, which can result in "dose stacking" and often fatality. This presentation will cover how to calculate an appropriate starting infusion dose of an opioid, how to titrate the basal dose, including how quickly you can titrate, and the magnitude of the increase, and how to write the order correctly. Participants will also learn about the importance of a clinician bolus, including what it is, when it should be administered, how to determine the dose, the pharmacokinetic explanation of the clinician bolus, and how to use administration data to further guide dosing. The final portion of this amazing program will include guidance on switching from a parenteral basal/bolus opioid regimen to an alternate regimen including different opioids and different routes of administration. Every palliative care prescriber should attend this presentation!

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