Question: I have a claimant who has been on opioids long term and is currently taking OxyContin® 80 mg twice daily and Dilaudid® 4 mg up to six times a day as needed for breakthrough pain. I am concerned with this dose as it seems to be a lot. Is there a maximum dose of opioids?

Unfortunately, this is a question without a straight-forward answer. Dosing of opioid medication like OxyContin® and Dilaudid® is variable and is highly dependent upon the patient. There is no maximum daily dose established for any of the opioids as dosing is typically based on patient response and tolerance; however, an initial starting dose, maintenance dose range, dose for conversion from other opioid therapy, and schedule for dose increases are usually included in each opioid's FDA-approved labeling. In general, the dose of opioid is started at the lowest level possible to achieve pain management and may be titrated upwards over a period of time if needed and as tolerated. Interestingly, two patients with the same type of injury and same demographics could require completely different opioid regimens for pain control.