Appropriate Use of Immediate-Release vs. Extended Release Opioids

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According to the Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain, 2022, when initiating opioid therapy clinicians should prescribe immediate-release (IR) opioids instead of extended-release and long-acting (ER/LA) opioids, which are slower acting medications with a longer duration of pain relieving action.

This guide provides definitions for opioid naïve and tolerant, identifies key differences between IR and ER/LA opioids, guides transitioning from IR to ER/LA, offers treatment pearls including opioid tapering algorithms, patient education and opioid disposal, provides comprehensive tables for commonly used IR and ER/LA opioids, and includes a morphine milligram equivalent conversion table.