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Tackling Opioid Abuse & Preventing Drug-Related Deaths

The United States is experiencing a significant public health threat from overdose deaths involving prescription opioids for the treatment of pain. The number of fatal outcomes involving opioid analgesics more than tripled in the last decade (Figure). “The reasons for increased mortality relating to opioid prescriptions are multifactorial,” says Lynn R. Webster, MD, FACPM, FASAM. “Prescriber behaviors, patient contributory factors, non-medical use patterns, and systemic failures are among the chief culprits. These factors—as well as others—all play a role in how opioids are viewed and utilized by physicians and may contribute to fears of prescribing these medications to patients in pain.” The FDA has instituted risk evaluation and mitigation strategies for opioids, but mortality associated with opioid prescribing continues to increase despite these efforts. Several risk factors have been identified for opioid-related overdose deaths. These include physician error due to knowledge deficits, patient non-adherence to medication regimens, and unanticipated medical and mental health comorbidities, including substance use disorders. Other risk factors include payer policies that encourage or mandate methadone as first-line therapy, the presence of additional central nervous system-depressant drugs (eg, alcohol, benzodiazepines, and antidepressants), and sleep-disordered breathing. “The analysis of risk factors is ongoing,” says Dr. Webster, “but pain care providers and public health officials must act now to prevent as many opioid-related deaths as possible.” Causes & Risk Factors for Opioid Abuse In the June 2011 supplement of Pain Medicine, Dr. Webster and other experts in pain management had several articles published on the root causes and risk factors pertaining to opioid-related deaths. The issue, available for free online at http://onlinelibrary.wiley.com, also discussed the extent to which measures enacted...

Striving Toward Quality Pain Management

The epidemic of untreated chronic or recurrent pain has lasted for decades, yet millions of people are still not adequately treated. One significant barrier to effective pain management is that clinicians and patients are often reluctant to talk about pain. Oftentimes, patients with pain believe their complaints aren’t taken seriously by their healthcare providers or they’re concerned about becoming addicted to certain pain medications. Many physicians also have difficulty managing pain, which can then have an impact on patient care and management. Some doctors have concerns or reservations about their ability to manage pain appropriately, the potential for substance abuse and addiction, or regulatory scrutiny. There is a significant knowledge deficit in the management of pain, especially when it comes to treatment options and the potential harms associated with available therapies. The unintended or undesirable side effects related to pain treatment can have a negative impact on patients, ranging from minor to life-threatening adverse events. Patient perceptions of side effects can also play a role. In some cases, patients may abandon their treatment due to side effects, even though these therapies have the potential to reduce pain and suffering and improve quality of life and physical function. “There is a significant knowledge in the management of pain, especially when it comes to treatment options and potential harms associated with available therapies.” Education is Critical No single treatment option for pain management is without risk, but physicians must also consider the risks involved with making decisions to not treat pain. There is a general lack of education in medical schools and during residency training on pain management. Many of the...
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