Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Discuss the findings of an updated review of 38 studies focused on problematic opioid use among patients with chronic pain.
- Review the implications of these findings.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwFeb4. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Take CME(click to view)
In recent years, clinicians have changed their attitudes regarding the use of opioids in light of the growing public health issue surrounding the potential of these drugs to be misused and abused. Risks associated with opioid use include overdose, drug dependence and subsequent withdrawal, addiction, and a negative impact on physical functioning.
“For many years, the United States went through a stretch when opioids were prescribed increasingly for pain relief,” explains Kevin E. Vowles, PhD. “Recent research, however, has indicated some potential problems associated with increases in opioid prescription rates. As a result, the prescribing of opioids is leveling off, but there is still a segment of the population that stands to benefit from using these medications.”
Experts have endorsed the notion that there is a need to differentiate and identify types of problems that may occur when using prescription opioids among patients with chronic pain. Some studies have attempted to calculate rates of problematic opioid use behavior, but these trials often suffer from imprecise and poorly defined terminology. “We’re lacking high-quality evidence on the identification of patients who are at risk for misusing and abusing opioids,” Dr. Vowles says.
An Updated Review
For a study published in Pain, Dr. Vowles and colleagues performed an updated review of problematic opioid use among patients with chronic pain. “Because previous reviews have indicated substantial variability in this literature,” says Dr. Vowles, “we took several steps to enhance precision and utility.”
The authors gathered data from 38 studies and explicitly coded the terms for rates of problematic opioid use in the available literature. They referred to different patterns of use, such as misuse, abuse, and addiction. The average prevalence rates were then calculated and weighted by sample size and study quality. The research team also examined the influence of differences in study methodology.
Overall, rates of problematic opioid use were broad, ranging from less than 1% to as high as 81% across studies. According to the research team, 76% of the studies examined in the analysis provided information on opioid misuse and 32% provided information on opioid addiction. Across most calculations, rates of opioid misuse ranged between 21% and 29%, whereas rates of opioid addiction were between 8% and 12%.
Just one of the 38 studies involved in the analysis reported data on the abuse of these drugs. When study methods were examined, the researchers observed that rates of addiction were lower in studies identifying prevalence assessments as a primary objective rather than a secondary one.
Dr. Vowles says his study team’s results are consistent with findings from previous research in many ways. “There continues to be substantial variability in studies evaluating problematic opioid use,” he says. “There were many different study designs, methods of identification, and settings that were used in the analyses examined in our review.” The range of rates of problematic use was broader than what has been previously reported in studies.
Based on the findings from Dr. Vowles and colleagues, misuse and addiction seem to be distinct patterns of problematic opioid use. It also appears that opioid misuse is more common than opioid addiction. Several types of misuse were identified, including:
- Erratic or disorganized use.
- Inappropriate use (eg, to manage symptoms other than pain).
- Use with alcohol or illegal substances.
“If it’s accurate that about one in four patients on opioids have patterns of misuse—but not addiction—then it may be more efficient to target safe treatment resources as interventions,” says Dr. Vowles. The study points out that some forms of misuse may be readily addressed with lower-intensity strategies, such as enhanced patient education or frequent follow-up visits.
The promotion of safer opioid use is paramount to curbing the epidemic of misuse, abuse, and addiction of these medications. The one-time rapid increase in opioid use had unintended consequences that—for some patients—means that more interventions will be needed to curtail problematic use and the potential for harm. “If opioids are here to stay, we must identify at-risk groups for addictive behaviors and tailor interventions to their needs,” Dr. Vowles says. “Simply not prescribing these medications at all will not cure the problem.” Pain treatment alternatives are available to healthcare providers who treat high-risk patients.
Dr. Vowles and colleagues provide several recommendations for future research on problematic opioid use in chronic pain (Table). “Overall, we need more studies with better trial designs,” says Dr. Vowles. “It has been established that opioids can help provide short-term pain relief, but their long-term efficacy must also be further investigated. Ultimately, this information may help clinicians better identify who is at risk and then develop targeted interventions to help reduce the opioid epidemic.”
Readings & Resources (click to view)
Vowles KE, McEntee ML, Julnes PS, Frohe T, New JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156:569-576. Available at: http://journals.lww.com/pain/Abstract/2015/04000/Rates_of_opioid_misuse,_abuse,_and_addiction_in.3.aspx.
Atluri S, Sudarshan G, Manchikanti L. Assessment of the trends in medical use and misuse of opioids analgesics from 2004 to 2011. Pain Physician. 2014;17:E119-E128.
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12:657-667.
Brown J, Setnik B, Lee K, et al. Assessment, stratification, and monitoring of the risk for prescription opioid misuse and abuse in the primary care setting. J Opioid Manag. 2011;7:467-483.