A 45 year old woman with chronic low back pain was initiated on

A 45 year old woman with chronic low back pain was initiated on extended-release (ER) oxycodone (10mg every 12 hours) two years ago after having inadequate pain control with several non-opioid strategies. She also takes melocicam 15mg once daily.

Three months ago her pain was moderately severe, but was not impairing her function, and she felt yoga played an important role in that. She also tried physical therapy and accupuncture with less benefit.

Today she reports midline low back pain that has been worsening and is now severe enough to prevent her from participating in yoga. She continues to work as a nanny and drives to work daily.

Her last urine drug test result and review of the prescription drug monitoring program (PDMP) report were as expected.

You and the patient decide to try increasing the dose of extended-release (ER) oxycodone to 15mg every 12 hours with follow up in two weeks.

What is the most appropriate advice to give this patient regarding driving and work-place safety, given the change in medication dosage?