Opioids are strong pain medicines used to treat medium to severe pain. Examples include oxycodone, hydrocodone (often combined with acetaminophen), and morphine.

Opioids can help with pain. They also have serious risks, especially with long-term use.

Possible risks include:

• Upset stomach, constipation, dizziness, or sleepiness
• Confusion or mood changes
• You may need more medicine over time to get the same effect
• Your body can get used to the drug
• Addiction or overdose (which can cause death)

The risk is higher if opioids are taken with:

• Alcohol
• Muscle relaxants
• Medicines for anxiety or sleep
  

These steps can help you stay safe. They may also help prevent delays at the pharmacy.

Try these options first

In many cases, non-opioid treatments work as well or better than opioids.

• Pain relievers like ibuprofen, naproxen, or acetaminophen 
• Medicines for nerve pain (like gabapentin or duloxetine)
• Physical therapy, exercise, massage, heat or ice
• Topical treatments like lidocaine or diclofenac gel
  

Talk with your doctor

• Use opioids only if your doctor believes they will help more than harm
• Talk with your doctor before starting and while taking opioids
  

If you take opioids, use them safely

• Take the medicine exactly as directed 
• Use the lowest dose for the shortest time 
• Do not drink alcohol while taking opioids
• Check with your doctor or pharmacist before taking other drugs
• Talk to your doctor about side effects or concerns
  

Protect yourself from overdose

• Ask if you should have naloxone (Narcan®)
• This medicine can reverse an overdose
• Show family or caregivers how to use it 
  

Call 911 right away if you notice signs of overdose

• Slow or shallow breathing
• Trouble waking up
• Extreme sleepiness
  

Keep medications safe and dispose of them properly

• Store opioids up and away, out of sight and reach of children, family members, and visitors 
• Keep them in a secure place, like a locked cabinet
• Never share your medication
• Safely dispose of unused opioids to prevent harm
• Ask your pharmacist about take-back locations or safe disposal options
• Learn more about safe disposal: https://www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html
  

Medicare has safety rules to help protect you when using opioids. Your pharmacy and Providence Medicare Advantage Plans follow these rules when you fill your prescription.  

Rules when starting opioids

• Your first prescription may be limited to a 7-day supply or less 
• It is safest to start at a low dose and increase slowly, if needed 
• Use only what you need and do not save extra medication
  

Safety check rules

Medicare requires safety reviews to help prevent harm. Your pharmacy or health plan may review your medications if:

• You are taking high doses of opioids
• You take opioids with certain other drugs (like medicines for anxiety or sleep)
• You use more than one doctor or pharmacy
  

In some cases:

• Your pharmacist may need to talk with your doctor
• Your doctor may need to provide more information before your prescription can be filled
  

If your pharmacy cannot fill your prescription or the full amount, you will get a notice. This notice will explain what to do next and how you or your doctor can contact us.

You or your doctor can:

• Ask for a coverage decision
• Ask for a faster review, if needed
• Ask for an exception to the rules
  

You can also ask for an exception before going to the pharmacy to help avoid delays.

Learn more on our Pharmacy Medicare Part D Coverage Determinations, Exceptions, Appeals, and Grievance page.

Rules if you already take opioids

• These limits usually do not apply if you take opioids regularly 
• If you do not fill them consistently, you may be treated as a new user
• This could cause delays when filling your prescription
  

Talk with your doctor about prescribing only the amount you use each month. This may help avoid delays.

Rules if your prescription is delayed or limited

• Your pharmacist will explain what to do next
• You or your doctor can contact the plan to:

You can also ask for an exception before going to the pharmacy to help avoid delays.

Drug Management Program (DMP)

• If there are safety concerns, your care may be coordinated to help keep you safe  
• You may be asked to use certain doctors or pharmacies
• You will receive a letter before any changes are made
• You can appeal if you disagree
  

These programs do not apply if you:

• Have cancer
• Are receiving hospice or end-of-life care
• Live in a long-term care facility
  

If you have any questions, please call Providence Medicare Advantage Plans at 503-574-8000 or 1-800-603-2340. TTY users should call 711. We are open 8 a.m. to 8 p.m. (Pacific Time) 7 days a week, October 1st through March 31st and Monday - Friday, April 1st through September 30th.

Other resources include:

• “Your Guide to Medicare Prescription Drug Coverage” at: www.Medicare.gov/publications/search
• “What do drug plans cover?” at: https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover
• Call the State Health Insurance Assistance Program (SHIP). Visit www.shiptacenter.org or call 1-800-MEDICARE for the phone number of your SHIP.
• For resources and information about the National Opioid Crisis, go to: www.hhs.gov/opioids
• For more information on what Medicare covers as well as drug coverage rules, visit Medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.