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Why Rethink Opioids?

Why We Must Rethink Opioids

For patients with chronic pain:
  • Are we prescribing opioids when clinically appropriate generally for patients with pain severe enough to require daily, around-the-clock, long-term treatment and for whom alternative treatment options are inadequate?
  • When we do prescribe opioids, are we applying universal precautions to help address misuse, abuse, and diversion?
 
Why Rethink Opioids?

Health care providers are challenged to provide relief to patients with chronic pain without exposing them or others to unnecessary risks.1 With opioid therapy, this may be easier said than done, due to the known risks and the difficulty in accurately predicting who might be at risk.1-4 Major risks associated with prescription opioid therapy include misuse, abuse, and diversion, dependence and withdrawal, addiction, and overdose.1,5

Concerns about prescription opioids have led some health care providers to reduce or eliminate use of these medications in the treatment of chronic pain.6,7 Patients also may have concerns about using opioid medications because of the well-publicized risks.7 Prescribing of opioid medications also has been subject to increased scrutiny and regulation.8-10 The fact remains, however, that for some patients, opioid medications can be a clinically appropriate element of an overall pain management plan comprising both pharmacologic and nonpharmacologic modalities.11-13

For prescription opioids to remain an option for appropriate patients with chronic pain, we all must take steps to help make certain that these medications are used properly. To this end, we propose that it is time for health care providers to Rethink Opioids so that these medications are used only when clinically appropriate, and to apply universal precautions when prescribing. This initiative is intended to help clinicians do just that.

References

  1. Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84(7):593-601. PMID: 19567713
  2. Brown J, Setnik B, Lee K, et al. Assessment, stratification, and monitoring of the risk for prescription opioid misuse and abuse in the primary care setting. J Opioid Manag. 2011;7(6):467-483. PMID: 22320029
  3. Salinas GD, Susalka D, Burton BS, et al. Risk assessment and counseling behaviors of healthcare professionals managing patients with chronic pain: a national multifaceted assessment of physicians, pharmacists, and their patients. J Opioid Manag. 2012;8(5):273-284. PMID: 23247904
  4. Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med. 2013;62(4):281-289. PMID: 23849618
  5. Centers for Disease Control and Prevention. Primary Care and Public Health Initiative. Prescription Drug Abuse and Overdose: Public Health Perspective. October 24, 2012. http://www.cdc.gov/primarycare/materials/opoidabuse/docs/pda-phperspective-508.pdf. Accessed May 20, 2014.
  6. 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.
  7. 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
  8. US Dept of Justice, Drug Enforcement Administration Website. State Prescription Drug Monitoring Programs: Questions and Answers. Updated October 11, 2011. http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm. Accessed October 8, 2014.
  9. Prescription Monitoring Program (I-STOP). New York State Register: June 19, 2013. http://docs.dos.ny.gov/info/register/2013/june19/pdf/rulemaking.pdf. Accessed May 20, 2014.
  10. National Conference of State Legislatures. Prevention of prescription drug overdose and abuse. Updated July 16, 2013. www.ncsl.org/issues-research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx. Accessed May 20, 2014.
  11. 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
  12. 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.
  13. 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.