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Why Rethink Opioids? Concerns of health care professionals and patients

Concerns About Opioid Therapy Remain Even When the Prescription Is Clinically Appropriate

Health care professionals and patients alike may have concerns with respect to opioid therapy for chronic pain. As a clinician, you may believe an opioid is the right choice clinically in a given situation, but you may feel uncertain about prescribing opioids, for any number of reasons.1-3 Will this patient misuse, abuse, or divert the medication? Will the patient become dependent or addicted? Will the presence of the medication in the patient’s home put family or friends at risk? Patients receiving an opioid prescription also may share many of these concerns.1 The potential result: you may not prescribe the opioid, or the prescription may be declined by the patient, and so the pain remains inadequately treated.1,4,5

One approach that may help reduce the risks and address concerns associated with clinically appropriate opioid therapy is the application of universal precautions with every patient being considered for or receiving prescription opioids for chronic pain.2,6-11

Note that the Rethink Opioids initiative focuses on practices that may help to reduce the risks for misuse, abuse, tampering, and diversion of prescription opioids.

References

  1. Matthias MS, Krebs EE, Collins LA, Bergman AA, Coffing J, Bair MJ. “I'm Not Abusing or Anything”: Patient-physician communication about opioid treatment in chronic pain. Patient Educ Couns. 2013;93(2):197-202. PMID: 23916677
  2. Webster LR, Fine PG. Approaches to improve pain relief while minimizing opioid abuse liability. J Pain. 2010;11(7):602-611. PMID: 20444651
  3. Matthias MS, Parpart AL, Nyland KA, et al. The patient-provider relationship in chronic pain care: providers' perspectives. Pain Med. 2010;11(11):1688-1697. PMID: 21044259
  4. Utah Department of Health. Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. Salt Lake City, UT: Utah Dept of Health; 2009. http://www.dopl.utah.gov/licensing/forms/OpioidGuidlines.pdf. Accessed May 20, 2014.
  5. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
  6. Chou R, Fanciullo GJ, Fine PG, et al; American Pain Society–American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130. PMID: 19187889
  7. US Department of Veterans Affairs, US Department of Defense. VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Version 2.0. Washington, DC: US Dept of Veterans Affairs, US Dept of Defense; 2010. http://www.va.gov/PAINMANAGEMENT/docs/CPG_opioidtherapy_summary.pdf. Accessed May 20, 2014.
  8. Washington State Agency Medical Directors’ Group (AMDG). Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An Educational Aid to Improve Care and Safety With Opioid Therapy. 2010 Update. Olympia, WA: Washington State Agency Medical Directors Group; 2010. http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf. Accessed May 20, 2014.
  9. Manchikanti L, Abdi S, Atluri S, et al; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2—guidance. Pain Physician. 2012;15(3 suppl):S67-S116. PMID: 22786449
  10. Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84(7):593-601. PMID: 19567713
  11. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107-112. PMID: 15773874