The alert pointed out the importance of assessing patients for pain thresholds. However, "notwithstanding the need for appropriate pain management," hospital providers should make staff aware of factors and activities that can help avoid accidental opioid overuse, such as assessing patients previous history of analgesic use or abuse, duration and possible side effects.
The alert advises providers to "Take extra precautions with patients who are new to opioids or who are being restarted on opioids," such as starting patients on a short-term trial at the lowest effective dose.
Patients at higher risk include those who snore, those who undergo upper abdominal or thoracic surgery, are receiving other sedating drugs such as benzodiazepines, antihistamines, diphenhydramine, sedatives, or other central nervous system depressants.
Risks also increase for those who are morbidly obese and also have sleep apnea, who have not recently used opioids, those who are under anesthesia for longer periods of time and for those who smoke cigarettes.