TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Humans
KW - Opioid-Related Disorders/prevention & control
KW - Pain/drug therapy
KW - Physicians
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'/statistics & numerical data
AU - T. Munzing
A1 - 
AB - Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.
AD - Family Medicine Residency Program Director for the Kaiser Permanente Orange County Area in Santa Ana, CA. Dr Munzing has more than ten years of experience as a Medical Expert Consultant for the Drug Enforcement Administration, the Medical Board of California, and other law enforcement agencies. tim.a.munzing@kp.org.
BT - The Permanente journal
C5 - Opioids & Substance Use
CY - United States
DO - 10.7812/TPP/16-169
JF - The Permanente journal
M1 - Journal Article
N2 - Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.
PP - United States
PY - 2017
SN - 1552-5775; 1552-5767
SP - 10.7812/TPP/16
EP - 169
EP - 
T1 - Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain
T2 - The Permanente journal
TI - Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain
U1 - Opioids & Substance Use
U2 - 28488993
U3 - 10.7812/TPP/16-169
VL - 21
VO - 1552-5775; 1552-5767
Y1 - 2017
ER -