Chronic Noncancer Pain Management and Opioid Overdose: Time to Change Prescribing Practices

2010 ◽  
Vol 152 (2) ◽  
pp. 123 ◽  
Author(s):  
A. Thomas McLellan
Keyword(s):  
Pain Management ◽  
Opioid Overdose ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals What are Future Pain Physicians Learning? A Survey of Opioid Prescribing Practices Among US Pain Fellowship Programs

2019 ◽  
Vol 6 (22;6) ◽  
pp. 549-554 ◽  
Author(s):  
Ferdinand Iannaccone
Keyword(s):  
United States ◽  
Pain Management ◽  
Clinical Training ◽  
The United States ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prescribe Opioid ◽  
Fellowship Programs ◽  
Noncancer Pain

Background: Pain physicians have long been seen as subspecialists that commonly prescribe opioid medications, but the reality exists that primary care, oncologists, and surgical subspecialists find themselves embroiled in these clinical decisions just as frequently. It is a reasonable hope that pain physicians emerge as leaders in navigating these muddy waters, and the most important time to engrave practice standards is during clinical training. Objectives: It was our hope to survey Accreditation Council for Graduate Medical Education (ACGME) pain fellowship programs throughout the United States in regard to practice behaviors for opioid prescribing in chronic noncancer pain (CNCP), and to assess what future pain physicians are learning during their training. Study Design: We developed a succinct, 8-question survey that attempted to gauge several aspects of opioid prescribing practices for CNCP. A survey was prepared in electronic format and e-mailed to each program director or chair of every ACGME accredited pain program in the United States. Methods: Our results were anonymously collected and percentage of response to each question was presented in bar graph format. The survey was prepared and initially sent out in November 2017 and intermittently redistributed through April 2018. Results: Of the 117 surveys sent through Survey Monkey, 42 responses were returned and collected, 39 fully completed surveys, and 3 partial completions, an estimate of roughly one-third of US ACGME pain fellowship programs. Limitations: Completion of our survey was voluntary, roughly 35% of ACGME programs submitted a response. Conclusions: Data displayed in collected responses illustrate that although there is variance in opioid prescribing practices for CNCP, many programs are limiting what they use opioids for and have substantial nonopioid pharmacologic and or interventional aspects to their practice. Future pain physicians throughout the country are learning diverse methods of pain management, with opioids being only a part of their toolbox. Key words: Opioids, ACGME, pain management fellowship, guidelines, teaching

scholarly journals Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Élise Roy ◽  
Richard J. Côté ◽  
Denis Hamel ◽  
Pierre-André Dubé ◽  
Éric Langlois ◽  
...  
Keyword(s):  
Online Survey ◽  
Family Physicians ◽  
Training Needs ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Pain Syndromes ◽  
Noncancer Pain ◽  
And Training

Aim. To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP). Methodology. An online survey was carried out in 2016. Results. Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions. This study provides insights into Québec family physicians’ concerns, practices, and needs with respect to the management of CNCP. Physicians’ difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.

scholarly journals Canadian Guidelines on Opioid Use Disorder Among Older Adults

2020 ◽  
Vol 23 (1) ◽  
pp. 123-134
Author(s):  
Launette M. Rieb ◽  
Zainab Samaan ◽  
Andrea D. Furlan ◽  
Kiran Rabheru ◽  
Sid Feldman ◽  
...  
Keyword(s):  
Older Adults ◽  
English Language ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Assessment And Treatment ◽  
Noncancer Pain ◽  
Health Canada

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 60 (1) ◽  
pp. e15-e26
Author(s):  
Michael Asamoah-Boaheng ◽  
Oluwatosin A. Badejo ◽  
Louise V. Bell ◽  
Norman Buckley ◽  
Jason W. Busse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Noncancer Pain

scholarly journals Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management

2019 ◽  
Vol 32 (4) ◽  
pp. 559-566
Author(s):  
Natalia P. Arizmendez ◽  
Fabiana Kotovicz ◽  
Jessica J. F. Kram ◽  
Dennis J. Baumgardner
Keyword(s):  
Pain Management ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Noncancer Pain

Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 1934-1941 ◽  
Author(s):  
Zayd Razouki ◽  
Bushra A Khokhar ◽  
Lindsey M Philpot ◽  
Jon O Ebbert
Keyword(s):  
Monitoring Program ◽  
Program Review ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Attitudes And Practices ◽  
Urine Drug ◽  
Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

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