From the Guidelines
In Massachusetts, a Primary Care Physician (PCP) should not prescribe more than 60 mg of oxycodone per day, which is equivalent to approximately 90 morphine milligram equivalents (MME) per day, as recommended by the CDC guidelines 1. When prescribing oxycodone, PCPs should follow the CDC's clinical practice guideline for prescribing opioids for pain, which provides a conversion factor of 1.5 for oxycodone to determine the dose in MMEs 1.
- The guideline recommends using the lowest effective dose and generally avoiding doses above 90 MME per day.
- For oxycodone, the conversion factor is 1.5, so 60 mg daily would be equivalent to 90 MME per day.
- Massachusetts law limits initial opioid prescriptions to a 7-day supply for acute pain, with exceptions for chronic pain, cancer pain, and palliative care.
- PCPs should also check the Prescription Monitoring Program before prescribing Schedule II or III opioids, document the reason for prescribing above certain thresholds, and provide naloxone prescriptions for patients on high doses.
- These regulations aim to balance effective pain management with minimizing risks of opioid dependence, addiction, and overdose.
- PCPs should carefully evaluate each patient's needs, consider non-opioid alternatives when possible, and implement risk mitigation strategies when prescribing higher doses of oxycodone.
From the Research
Daily Dosage Limit of Oxycodone in Massachusetts
- The daily dosage limit of oxycodone that a Primary Care Physician (PCP) can prescribe in Massachusetts is not explicitly stated in the provided studies.
- However, according to the study 2, 14 states imposed limits on the dosage of opioids that can be prescribed, ranging from 30 morphine milligram equivalents (MME) to a 120 MME daily maximum.
- It is worth noting that the study 2 does not specifically mention Massachusetts, but it provides information on the varying dosage limits imposed by different states.
- In terms of oxycodone dosage, the study 3 found that the median dose of sustained-release oxycodone was 80 mg for patients prescribed twice daily dosing, 60 mg when prescribed 3 times daily, and 120 mg when 4 times daily.
- Another study 4 found that pain relief was obtained with doses up to 60 mg every 4 hours in patients with chronic cancer pain.
- The study 5 found that participants ingested a median of 6 (3-9.5) oxycodone digital pills over the course of 7 days, with 82% of the oxycodone dose ingested in the first 3 days, which translates to a median opioid ingestion of 45-mg morphine equivalents for acute pain over 7 days.
- The study 6 proposed dose-specific concentration ranges for oxycodone, but it does not provide information on the daily dosage limit.
Prescribing Limits in Massachusetts
- To determine the daily dosage limit of oxycodone that a PCP can prescribe in Massachusetts, it is recommended to consult the Massachusetts state laws and regulations regarding opioid prescribing.
- The study 2 suggests that states have varying laws and regulations regarding opioid prescribing, and it is possible that Massachusetts has its own specific laws and guidelines.
- It is also important to note that the daily dosage limit of oxycodone may vary depending on the individual patient's needs and medical condition.