TY - JOUR
KW - Algorithms
KW - Analgesics, Opioid/administration & dosage/therapeutic use
KW - Chronic Pain/drug therapy
KW - Humans
KW - Physicians, Primary Care
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'/standards
KW - Risk Assessment
KW - Substance-Related Disorders/prevention & control
AU - E. J. Cone
AU - A. Z. DePriest
AU - A. Gordon
AU - S. D. Passik
A1 - 
AB - Opioids are increasingly prescribed to provide effective therapy for chronic noncancer pain, but increased use also means an increased risk of abuse. Primary care physicians treating patients with chronic noncancer pain are concerned about adverse events and risk of abuse and dependence associated with opioids, yet many prescribers do not follow established guidelines for the use of these agents, either through unawareness or in the mistaken belief that urine toxicology testing is all that is needed to monitor compliance and thwart abuse. Although there is no foolproof way to identify an abuser and prevent abuse, the best way to minimize the risk of abuse is to follow established guidelines for the use of opioids. These guidelines entail a careful assessment of the patient, the painful condition to be treated, and the estimated level of risk of abuse based on several factors: history of abuse and current or past psychiatric disorders; design of a therapeutic regimen that includes both pharmacotherapeutic and nonpharmacologic modalities; a formal written agreement with the patient that defines treatment expectations and responsibilities; selection of an appropriate agent, including consideration of formulations designed to deter tampering and abuse; initiation of treatment at a low dosage with titration in gradual increments as needed to achieve effective analgesia; regular reassessment to watch for signs of abuse, to perform drug monitoring, and to adjust medication as needed; and established protocols for actions to be taken in case of suspected abuse. By following these guidelines, physicians can prescribe opioids to provide effective analgesia while reducing the likelihood of abuse.
BT - Postgraduate medicine
C5 - Opioids & Substance Use; Education & Workforce
CP - 7
CY - England
DO - 10.3810/pgm.2014.11.2841
IS - 7
JF - Postgraduate medicine
N2 - Opioids are increasingly prescribed to provide effective therapy for chronic noncancer pain, but increased use also means an increased risk of abuse. Primary care physicians treating patients with chronic noncancer pain are concerned about adverse events and risk of abuse and dependence associated with opioids, yet many prescribers do not follow established guidelines for the use of these agents, either through unawareness or in the mistaken belief that urine toxicology testing is all that is needed to monitor compliance and thwart abuse. Although there is no foolproof way to identify an abuser and prevent abuse, the best way to minimize the risk of abuse is to follow established guidelines for the use of opioids. These guidelines entail a careful assessment of the patient, the painful condition to be treated, and the estimated level of risk of abuse based on several factors: history of abuse and current or past psychiatric disorders; design of a therapeutic regimen that includes both pharmacotherapeutic and nonpharmacologic modalities; a formal written agreement with the patient that defines treatment expectations and responsibilities; selection of an appropriate agent, including consideration of formulations designed to deter tampering and abuse; initiation of treatment at a low dosage with titration in gradual increments as needed to achieve effective analgesia; regular reassessment to watch for signs of abuse, to perform drug monitoring, and to adjust medication as needed; and established protocols for actions to be taken in case of suspected abuse. By following these guidelines, physicians can prescribe opioids to provide effective analgesia while reducing the likelihood of abuse.
PP - England
PY - 2014
SN - 1941-9260; 0032-5481
SP - 129
EP - 138
EP - 
T1 - Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2: best practices
T2 - Postgraduate medicine
TI - Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2: best practices
U1 - Opioids & Substance Use; Education & Workforce
U2 - 25387221
U3 - 10.3810/pgm.2014.11.2841
VL - 126
VO - 1941-9260; 0032-5481
Y1 - 2014
ER -