Safe Prescriber Pledge Program

Did you know that prescription pain killers and opioids can lead to addiction, substance abuse and overdose?

According to the National Institute on Drug Abuse, more than 75% of people who go on to develop a substance use disorder start with medication prescribed to them by their primary care provider. By making the community aware of the risks of prescribing opioid pain medications and engaging practitioners to follow safe pain medication prescribing guidelines, it will reduce the reliance on opioid medication that is the root cause of so much addiction.


Signed Pledges

Staten Island Performing Provider System is calling together primary care doctors, nurse practitioners, pain management specialists, pharmacists and other prescribers on Staten Island to Take the Safe Prescriber Pledge! Medical professionals who take the Safe Prescriber Pledge will be supporting the battle against the opioid overdose epidemic. Safe prescribing guidelines, as defined by the CDC, limit the use of potentially addictive medications in their practices.

How to take the Safe Prescriber Pledge: Click on the “Take the Pledge” link below and fill out the form. If you have a paper copy of the pledge, you can fax it to us at (917) 830-1147. We will send you a confirmation email once we’ve received your form.



“We’ve seen far too often how one prescription can lead to a life-threatening addiction—which is why this Safe Prescriber Pledge, and all the efforts to bring more education and resources to the table, will have an impact on turning the tides of this public health crisis. We truly need all hands on deck, and I’m proud to be a part of this comprehensive effort.” Congressman Max Rose

Representing New York's 11th District

Safe Prescriber Pledge

Staten Island Performing Provider System’s Safe Prescriber Pledge is part of the initiative to address the opioid epidemic. Medical professionals who sign this pledge are adopting practices that ensure safe prescribing of potentially addictive medicines.

 I, _________________________________________, pledge to:

  1. Prioritize non-opioid treatment options for pain
  2. Utilize the Opioid Risk Tool (ORT)* to screen all patients before prescribing controlled substances
  3. Use the NYS Prescription Monitoring Program (I Stop) before writing any prescription for opiates, benzodiazepines, Medication Assisted Treatment (MAT) medications
  4. Follow Centers for Disease Control (CDC) guidelines for initial and chronic medication dosing*
  5. Obtain patient agreement on the risks and benefits of opioids to patients who would be receiving acute and chronic opioid prescriptions*
  6. Maintain an office policy and procedure* on safe and effective management of prescribing Controlled Substances (CS).
  7. Prescribe Narcan for all patients on chronic opiates and MAT* and:
    1. Demonstrate how to use Narcan
    2. Share information about Narcan
    3. Distribute Narcan educational materials
  8. Offer patients on chronic opiates, benzodiazepines and MAT information on “Tamper Resistant” caps, bottles or other medication containers
  9. Complete a three-hour CME course in Pain Management, Palliative Care and Addiction every 3 years*
  10. Promote safe return of unused controlled medications

*Supporting documents found in Staten Island PPS Safe Prescriber Pledge Toolkit.