Jan 2026

When Opioids Are Necessary: Safer Prescribing with the Texas Prescription Monitoring Program 

Note: This article provides general information to support reflection and continued learning about integrating PMP checks and results review into practice.

There are times when opioids are the right choice for a patient. These medications can be an important part of a care plan, whether it’s managing acute pain after surgery or supporting a difficult recovery. The challenge lies in finding the right balance by using them effectively while minimizing the risk of dependence or misuse. The Texas Prescription Monitoring Program (PMP) can help guide these decisions to improve patient safety. 

Understanding the 2022 CDC Guidelines
The 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain provide 12 recommendations to promote safe and effective pain management. The summary below highlights the key points, but providers are encouraged to review the full guidelines when making treatment decisions.

The recommendations are grouped into four areas:  

1. Deciding whether opioids are the correct choice. Nonopioid treatments are often a first-line option for many types of pain. If considering opioids, discuss risks, benefits and treatment goals with the patient. Review goals for function, pain management and possible discontinuation. 
2. Choosing and dosing appropriately. Immediate-release opioids prescribed at the lowest effective dose are generally recommended when starting therapy. Opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from higher dosages for ongoing treatment. 
3. Determining duration of therapy. Prescribe only the quantity needed for the expected duration of pain. Schedule follow-ups to monitor progress and make timely adjustments. 
4. Managing risks. Check the Texas PMP to review the patient’s controlled substance history. Consider offering naloxone and explore evidence-based treatment options if opioid use disorder is a concern.

 The Texas PMP as a Partner in Care
 The Texas PMP mandate requires clinicians to check the PMP before prescribing opioids, benzodiazepines, barbiturates or carisoprodol. A quick look at the PMP can reveal overlapping medications, flag potential misuse and guide better conversations. 

Use the Texas PMP to ask: 

• Has the patient already received similar controlled substance prescriptions elsewhere, including additive, synergistic or other controlled medications? 

• Should you reassess their current pain management plan? 

Knowing About Prescription Coverage Changes for Controlled Substance Prescriptions
Many insurance plans, including Medicare and Medicaid, are introducing dosage thresholds and limited days' supply (for example, a seven-day supply is allowed for acute pain) and prior authorization requirements for certain opioid prescriptions. It may not be feasible to track every policy change, but it’s helpful to be aware that these requirements are becoming more common. Encouraging your practice to stay informed can reduce the chances of unexpected denials. It’s also a good idea to have a backup plan in place to support patients if a prescription is delayed, denied or has a high out-of-pocket expense.

The Texas PMP is a powerful tool to support safe, informed decision-making while keeping opioids as an important option when used appropriately. Apply CDC guidelines, Texas regulations and the Texas PMP together to ensure opioids are prescribed only when necessary and for the appropriate duration. 

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