Opioid No No’s

Indiziert: 2026-05-18

[00:00:00]Please don't do this. What not to do with opioids. Okay, but seriously, these are a couple of things that we've seen recently in my palliative practice and please for the love of God do not do these things. Number one, start an opioid naive person on a fentanyl patch.

[00:00:15]Like, just don't do it, okay? You need to start a short-acting opioid and see what they need and then if they're needing medication around the clock or really often, then consider a fentanyl patch. But really there are other options you should be going to first. So just don't do it. Number two is starting an opioid naive person on methadone. So same thing. Methadone is very long-acting and it works really well, but for somebody who has already been usually using opioids because it is also very potent. So let's not overdose somebody on methadone. Last but not least, for new onset acute pain, let's not jump straight to a PCA of IV Dilaudid. I think it's reasonable to give IV doses in acute pain crisis and make sure that someone is comfortable, but we don't just slap a PCA on somebody right away. But like generally we're going to use IV pushes before we start a PCA. And then if someone is needing a ton of IV pushes, then we can add a PCA, but not right away. Please don't do this. Okay, so that's my public service announcements for the day. Enjoy and let me know what questions you have. What other things can you think of that we should not do with opioids?