Get the latest facts and analyses on the most important issues related to smoking, vaping, nicotine and substance use.

All prescription sleeping pills have risks, especially for people with certain medical conditions, including liver or kidney disease, and for older adults. Always talk with your health care provider before trying a new treatment for insomnia.

Expected functional benefits of opioid use should be clear, with the continuation of opioid therapy dependent on achieving them. While improved sleep and mood are somewhat subjective and should be noted, seek more objective evidence of benefit in order to prescribe and continue opioid therapy.

In Michigan, laws regarding opioid prescribing require the patient to sign a Start Talking Form, in which they acknowledge in writing that they have been educated about the risks of opioid treatment. This is not the same as informed consent; the Start Talking Form does not meet the legal definition of consent.

A chronic secondary pain syndrome initially manifests as a symptom of another disease and then continues after successful treatment of the disease.15

When treatment goals have been met or when progress plateaus, formal therapy may be discontinued, but advise patients to continue with a program of independent daily home exercise.

If a patient was previously stable on an opioid but requests an increase in dose, assess for tolerance or opioid failure. Consider if tapering down the opioid dose or converting to buprenorphine may be indicated.

Sometimes prescription medicines used mainly to treat depression may ease insomnia when taken in lower doses.

Some evidence shows that patients with complex persistent dependence may tolerate transition to buprenorphine better than a tapering down of the opioid dose. When complex persistent dependence is suspected, a more clinically useful approach may be to transition to buprenorphine and then taper down the dose.

Compounded topical 5% morphine can provide local wound analgesia and may promote healing. It is only available at compounding pharmacies and can be expensive.

Start opioids at low doses to avoid respiratory depression, which is most likely to occur in the first 24 hours. Use extra caution in patients with COPD or obstructive sleep apnea.

Have you try a different prescription sleeping pill if the first medicine you take doesn't work after the full prescribed course

Provide support. A patient should not be made to feel judged, scorned, or abandoned by a clinician just because a diagnosis of opioid use disorder is made.

Transcutaneous electrical nerve stimulation (TENS). Consider TENS either along with physical therapy or Pain Management as an adjunct to multimodal treatment. TENS applies low voltage electrical stimulation using skin contact electrodes.