Patient Information

Prescriber Information

Surgery Type


Opioid Status

History of Mental Health Dx


Follow Your Recovery

We urge you to use this worksheet to think about your opioid usage over the next few days/weeks.

Dosage Tracker

  • Most people take the medication this long.
  • Prepare to stop your medication.
  • Consult your doctor if you are still in pain.
  • Your prescription ends here.

Prescription Information

  • mg x per day
  • Please remember: You can finish your prescription. However, you are always free to take less.
  • patients needed a refill on their prescriptions after finishing their medication.

Pain Scale

% of patients found their pain intolerable after finishing their medication.

Important Information

  • Use the medication only as prescribed. Take with food.
  • Do not drive or use any type of heavy machinery, drink alcohol, make any life-changing decisions (i.e. sign a will) or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity.
  • On rare occasions these medications may cause confusion or disorientation, and we advise you to discontinue these medications should these occur.

Responsible use of opioids

  • Don't take more medicine than the prescribed one, don't take it more frequently than instructed.
  • Disclose all information about all the medicine you take or may take. Side effects can be worse under the influence of additional medicine.
  • Don't drink alcohol while taking opioid pain medicine.
  • Be aware of the partial fill. If you feel unease having opioids at home, you can ask for only a part of the prescription at your pharmacists and then ask for the other part if you need it.
  • Your opioid medicine may contain acetaminophen. Don't take more medicine containing acetaminophen, as it may lead to liver damage.
  • When you don’t need this medicine anymore, safely dispose of anything that is left over. Ask your doctor for a drop box location.
  • As your pain eases, wait longer between each pill.
Source :

Common side effects

  • Feeling sleepy or dizzy.
  • Itching, talk to your doctor if this happens to you.
  • Constipation. Drink plenty of fluids, and talk to your doctor in case you consider there is need for a stool softener.
  • Nausea/Vomiting.
  • Low Energy / Sex Drive
Source : National Institute on Drug Abuse via USA Today

Opioid Addiction

You are at a higher risk of developing dependence if you:
  • If you have experienced depression or anxiety.
  • If you have abused of alcohol, tobacco, or drugs (prescription or street drugs).
  • Have a history of chronic pain.
  • If you take opioids for longer than 1 week.
  • Take more pills, more often, than your doctor prescribed.

Anyone can overdose. Please call 911 in case of emergencies.