Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

2018 ◽  
Author(s):  
Sairam Atluri ◽  
Gururau Sudarshan
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Drug Abuse ◽  
Prescription Opioid ◽  
Dose Limitation ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Pain Patients ◽  
Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

2018 ◽  
Author(s):  
Sairam Atluri ◽  
Gururau Sudarshan
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Drug Abuse ◽  
Prescription Opioid ◽  
Dose Limitation ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Pain Patients ◽  
Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse

2021 ◽  
Author(s):  
Sairam Atluri ◽  
Gururau Sudarshan
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Drug Abuse ◽  
Prescription Opioid ◽  
Dose Limitation ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Pain Patients ◽  
Prescription Opioid Abuse

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed. This review contains 3 figures, 4 tables, and 98 references. Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening

Distress intolerance and prescription opioid abuse in chronic pain patients

2015 ◽  
Vol 156 ◽  
pp. e146-e147
Author(s):  
Kate McHugh ◽  
Robert R. Edwards ◽  
Robert N. Jamison ◽  
Marise C. Cornelius ◽  
Roger Weiss
Keyword(s):  
Chronic Pain ◽  
Opioid Abuse ◽  
Prescription Opioid ◽  
Distress Intolerance ◽  
Chronic Pain Patients ◽  
Pain Patients ◽  
Prescription Opioid Abuse

scholarly journals Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. S67-ES92 ◽  
Author(s):  
Nalini Sehgal
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
The Past ◽  
Noncancer Pain ◽  
Prescription Opioid Abuse

Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self medication, use for reward, compulsive use because of addiction, and diversion for profit. Treatment approaches that balance treating chronic pain while minimizing risks for opioid abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic noncancer pain has increased dramatically in the past 2 decades in conjunction with a marked increase in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method of selecting patients for opioid therapy, predicting risk, and identifying problems once they arise could be of enormous benefit. Such an instrument could potentially curb the risk of iatrogenic addiction. Although several screening instruments and strategies have been introduced in the past decade, there is no single test or instrument that can reliably and accurately predict patients who are not suitable for opioid therapy or identify those who need increased vigilance or monitoring during therapy. At present, screening for opioid abuse includes assessment of premorbid and comorbid substance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; and utilization of opioid assessment screening tools. Multiple opioid assessment screening tools and instruments have been developed by various authors. In addition, urine drug testing, monitoring of prescribing practices, prescription monitoring programs, opioid treatment agreements, and utilization of universal precautions are essential. Presently, a combination of strategies is recommended to stratify risk, identify and understand aberrant drug related behaviors, and tailor treatments accordingly. This manuscript will review the current state of knowledge regarding the growing problem of opioid abuse and misuse; known risk factors; and methods of predicting, assessing, monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain. Key words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, risk management, drug monitoring, aberrant drug-related behavior

scholarly journals Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1

2017 ◽  
Vol 2 (20;2) ◽  
pp. s93-s111 ◽  
Author(s):  
Alan D. Kaye
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Drug Testing ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Self Medication ◽  
Prescription Opioid Abuse

Chronic pain and prescription opioid abuse are extremely prevalent in the United States and worldwide. The consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. The risk for misuse of prescribed opioids is much higher in patients with chronic pain, especially those with concurrent substance use and /or mental health disorders. Several reasons can account for the occurrence of opioid abuse and misuse, including self-medication, use for reward, compulsive use related to addiction, and diversion for profit. There is a need, therefore, for therapeutic approaches that balance treating chronic pain, while minimizing risks for opioid abuse, misuse, and diversion. Chronic opioid therapy for chronic non-cancer pain has seen a dramatic increase throughout the past 2 decades in conjunction with associated increases in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method for selecting patients for opioid therapy, predicting risk, and identifying problems once they have arisen, could be of enormous benefit in clinical practice. An instrument as such has the potential to attenuate the risk of iatrogenic addiction. Despite the recent introduction of various screening strategies and instruments, no single test or instrument can reliably and accurately predict those patients unsuitable for opioid therapy or pinpoint those requiring heightened degrees of surveillance and monitoring throughout their therapy. Current opioid abuse screening tactics include assessing premorbid and comorbid substance abuse; assessing aberrant drug-related behaviors; stratification of risk factors; and utilizing opioid assessment screening tools. Several authors have contributed numerous screening tools and instruments to aid the assessment of appropriate opioid therapy. Additional essential measures include urine drug testing, prescription practice monitoring programs, opioid treatment agreements, and implementing universal precautions. Presently accepted recommendations consist of a combination of strategies designed to stratify risk, to identify and to understand aberrant drug-related behaviors, and to tailor treatments accordingly. This manuscript, Part 2 of a 2 part update, builds on the 2012 opioid guidelines published in Pain Physician, and the 2016 guidelines released by the Centers for Disease Control and Prevention. It reviews screening, monitoring, and addressing opioid abuse and misuse in patients with chronic non-cancer pain. Key words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, risk management, drug monitoring, aberrant drug-related behavior

scholarly journals Mental health and opioid addiction comorbidities among chronic pain patients

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kevin Cevasco ◽  
Bill Saunders
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Opioid Addiction ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Pain Patients ◽  
Pain Patients

ObjectiveAssessing mental health and opioid addiction comorbidities among chronic pain patients using a large longitudinal clinical, operational, and laboratory data set.IntroductionThe National Institute for Drug Abuse Report, Common Comorbidities with Substance Use Disorders, states there are “many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.”(1) Prescription opioids are amongst the most commonly used drugs that lead to illicit drug use.(2)Much of the data about the starting point of the prescription opioid addiction is in the patient health history and is recorded within the provider electronic health record and administrative systems.DescriptionThere are a variety of addiction and misuse risk screening tools available and selecting appropriate tools screening can be confusing for providers. Examples of common screening tools: Opioid Abuse Risk Screener (OARS), Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP), Current Opioid Misuse Measure (COMM), Diagnosis, Intractability, Risk, and Efficacy (DIRE). These opioid risk screening tools are interview based and vary in how they survey for psychosocial factors. The screening tools are useful, but are meant only to alert the provider to conduct further investigation.(3)Understanding how the comorbidities recorded in the patient’s clinical interactions may help improve risk assessment investigations and ongoing monitoring programs. Studying the chronic pain patients’ longitudinal clinical, operational, and laboratory records provides the basis for better study controls than those using population based on emergency department admission and mortality events.MethodsThe analysis leverages IBM's Explorys electronic health record (EHR) data, a large integrated source of real world clinical, operational and lab data across 39 large integrated delivery networks that span the continuum of care. In addition to demographic characteristics of drug abusers, we will describe common comorbidities of selected mental health diagnoses, examine coding-related issues, distinguish chronic and episodic addiction and look for regional differences due to state/local level prescribing training and provider addiction awareness.How the Moderator Intends to Engage the Audience in Discussions on the TopicPromote the event through interatction with the @ISDS twitter account and #ISDS19 hashtag.Solicit question for presenters-panelists through social media before the briefing, and meet with presenters before the event to tune the presenations to areas of interest.Conduct a demographic poll of the audience to get them engaged. Ask audience to stand to show their organization-role. e.g. state-local public health, provider, vendor. This helps the presenters adapt to the audience profile.After each panelist speaks, have the panelist ask a question to the audience about a lingering question that arose during the research. Limit the audience to ~1 minute to answer. Allow panelists to ask a few more questions if the process is working, but limit to overall event time schedule.Finish with Q&A from the audience.References1. Abuse NI on D. Part 1: The Connection Between Substance Use Disorders and Mental Illness [Internet]. [cited 2018 Sep 29]. Available from: https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness2. Lankenau SE, Teti M, Silva K, Bloom JJ, Harocopos A, Treese M. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012 Jan 1;23(1):37–44.3. Hudspeth RS. Safe Opioid Prescribing for Adults by Nurse Practitioners: Part 1. Patient History and Assessment Standards and Techniques. J Nurse Pract. 2016 Mar;12(3):141–8. 

Association Between Urine Drug Test Results and Treatment Outcome in High-Risk Chronic Pain Patients on Opioids

2010 ◽  
Vol 4 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Kelly S. Barth ◽  
William C. Becker ◽  
Nancy L. Wiedemer ◽  
Shahrzad Mavandadi ◽  
David W. Oslin ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Treatment Outcome ◽  
High Risk ◽  
Test Results ◽  
Drug Test ◽  
Chronic Pain Patients ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Pain Patients
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