Opioid Safety

Common prescription opioids include:

• Oxycodone (OxyContin^®, Percocet^®, Roxicodone^®)
• Hydrocodone (Vicodin^®, Lorcet^®, Norco^®)
• Morphine (MS Contin^®)
• Codeine (Tylenol^® with codeine)
• Tramadol (Ultram^®)
• Methadone

Opioids are highly addictive, even when taken as directed. The longer you take them, the more likely you are to become addicted.

There is also a risk of side effects when taking opioids with certain medications. For example, combining an opioid with a benzodiazepine—like alprazolam (Xanax^®), clonazepam (Klonopin^®), or diazepam (Valium^®)—might cause a dangerous drug interaction that could lead to an accidental overdose.

If you suspect that someone has overdosed, please call 911.  You can give the person a medication called Naloxone to reverse the overdose while waiting for a medical response. If you give someone Naloxone, observe them constantly until emergency care arrives to make sure their breathing does not slow or stop. Our formulary includes generic Narcan, a nasal spray containing Naloxone. (You can work with your prescriber or pharmacist to decide the best option for you to have on hand, and check the medication tier by using the formulary search tool.)

Because opioids carry such serious risks, Advantage MD conducts reviews or safety edits whenever a member:

• Receives opioid prescriptions from three or more prescribers and takes a total of 90 Morphine Milligram Equivalents (MME) or more per day,
• Receives prescriptions for both an opioid and a benzodiazepine, OR
• Receives prescriptions for both an opioid and a buprenorphine.

In each of these situations, the pharmacist can override the review or safety edit by consulting with the prescriber(s) to determine the medical necessity of the member’s prescriptions. If the pharmacist is unable or unwilling to override the review or safety edit, the member, member’s representative and/or prescriber can submit a coverage determination.

For members who have not filled an opioid prescription in the past 108 days, we limit their initial opioid prescriptions for treatment of acute pain to no more than a 7-day supply. Pharmacists can override this review by assessing the member’s opioid fill history. The member, member’s representative and/or prescriber can submit a coverage determination to get more than a 7-day supply.

Sharing prescribed medication is illegal and potentially dangerous. If you have extra unused or unwanted medications, please dispose of them through a Drug Take-Back program.

• Johns Hopkins Medicine participates in yearly drug take back events. Check here for more information about upcoming events.
• Search for year-round pharmaceutical disposal locations by zip code.
• While it’s best to use a Drug Take-Back program or location, most opioids are on the FDA Flush List and may be flushed down the toilet to ensure that they are not accidentally or intentionally ingested, touched, misused, or abused.

• Put all medication away and out of children’s reach and sight.
• Always relock the cap on the medicine bottle.
• Do not share your medication.
• Safely dispose of unused pills.

• Taking a prescription opioid is not the only option for managing pain successfully. You and your doctor should work together to come up with a pain plan. It may include:
  • Understanding how your medications work and how they will impact your body
  • Discussing medication risks with your doctor
  • Learning about non-opioid options, such as:
    • Occupational and/or physical therapy
    • Acupuncture
    • Chiropractic care
    • Stress management or depression treatment
    • Over-the-counter remedies, such as ibuprofen
    • Ice and heat therapy
    • Exercise
    • Massage
  • Staying active in spite of your pain
  • Keeping a pain diary to help guide you and your doctor in managing your pain
  • Identifying a support network
  • Maintaining a healthy diet

Call our Behavioral Health Services at 410-424-4476, Monday through Friday from 8 a.m. to 5 p.m.