TY - JOUR
KW - Adult
KW - Analgesics, Opioid/administration & dosage/poisoning/therapeutic use
KW - Chronic Pain/drug therapy
KW - Drug Overdose/prevention & control
KW - Humans
KW - Medication Adherence
KW - Opioid-Related Disorders/prevention & control
KW - Practice Guidelines as Topic/standards
KW - Risk Assessment
KW - United States
KW - Urinalysis
AU - T. K. Nuckols
AU - L. Anderson
AU - I. Popescu
AU - A. L. Diamant
AU - B. Doyle
AU - P. Di Capua
AU - R. Chou
A1 - 
AB - BACKGROUND: Deaths due to prescription opioid overdoses have increased dramatically. High-quality guidelines could help clinicians mitigate risks associated with opioid therapy. PURPOSE: To evaluate the quality and content of guidelines on the use of opioids for chronic pain. DATA SOURCES: MEDLINE, National Guideline Clearinghouse, specialty society Web sites, and international guideline clearinghouses (searched in July 2013). STUDY SELECTION: Guidelines published between January 2007 and July 2013 addressing the use of opioids for chronic pain in adults were selected. Guidelines on specific settings, populations, and conditions were excluded. DATA EXTRACTION: Guidelines and associated systematic reviews were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and A Measurement Tool to Assess Systematic Reviews (AMSTAR), respectively, and recommendations for mitigating opioid-related risks were compared. DATA SYNTHESIS: Thirteen guidelines met selection criteria. Overall AGREE II scores were 3.00 to 6.20 (on a scale of 1 to 7). The AMSTAR ratings were poor to fair for 10 guidelines. Two received high AGREE II and AMSTAR scores. Most guidelines recommend that clinicians avoid doses greater than 90 to 200 mg of morphine equivalents per day, have additional knowledge to prescribe methadone, recognize risks of fentanyl patches, titrate cautiously, and reduce doses by at least 25% to 50% when switching opioids. Guidelines also agree that opioid risk assessment tools, written treatment agreements, and urine drug testing can mitigate risks. Most recommendations are supported by observational data or expert consensus. LIMITATION: Exclusion of non-English-language guidelines and reliance on published information. CONCLUSION: Despite limited evidence and variable development methods, recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug-drug and drug-disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing. Future research should directly examine the effectiveness of opioid risk mitigation strategies. PRIMARY FUNDING SOURCE: California Department of Industrial Relations and California Commission on Health and Safety and Workers' Compensation.
BT - Annals of Internal Medicine
C5 - Opioids & Substance Use
CP - 1
CY - United States
DO - 10.7326/0003-4819-160-1-201401070-00732
IS - 1
JF - Annals of Internal Medicine
N2 - BACKGROUND: Deaths due to prescription opioid overdoses have increased dramatically. High-quality guidelines could help clinicians mitigate risks associated with opioid therapy. PURPOSE: To evaluate the quality and content of guidelines on the use of opioids for chronic pain. DATA SOURCES: MEDLINE, National Guideline Clearinghouse, specialty society Web sites, and international guideline clearinghouses (searched in July 2013). STUDY SELECTION: Guidelines published between January 2007 and July 2013 addressing the use of opioids for chronic pain in adults were selected. Guidelines on specific settings, populations, and conditions were excluded. DATA EXTRACTION: Guidelines and associated systematic reviews were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and A Measurement Tool to Assess Systematic Reviews (AMSTAR), respectively, and recommendations for mitigating opioid-related risks were compared. DATA SYNTHESIS: Thirteen guidelines met selection criteria. Overall AGREE II scores were 3.00 to 6.20 (on a scale of 1 to 7). The AMSTAR ratings were poor to fair for 10 guidelines. Two received high AGREE II and AMSTAR scores. Most guidelines recommend that clinicians avoid doses greater than 90 to 200 mg of morphine equivalents per day, have additional knowledge to prescribe methadone, recognize risks of fentanyl patches, titrate cautiously, and reduce doses by at least 25% to 50% when switching opioids. Guidelines also agree that opioid risk assessment tools, written treatment agreements, and urine drug testing can mitigate risks. Most recommendations are supported by observational data or expert consensus. LIMITATION: Exclusion of non-English-language guidelines and reliance on published information. CONCLUSION: Despite limited evidence and variable development methods, recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug-drug and drug-disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing. Future research should directly examine the effectiveness of opioid risk mitigation strategies. PRIMARY FUNDING SOURCE: California Department of Industrial Relations and California Commission on Health and Safety and Workers' Compensation.
PP - United States
PY - 2014
SN - 1539-3704; 0003-4819
SP - 38
EP - 47
EP - 
T1 - Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain
T2 - Annals of Internal Medicine
TI - Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain
U1 - Opioids & Substance Use
U2 - 24217469
U3 - 10.7326/0003-4819-160-1-201401070-00732
VL - 160
VO - 1539-3704; 0003-4819
Y1 - 2014
ER -