Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2: best practices

Edward J. Cone, Anne Z. DePriest, Allan Gordon, Steven D. Passik

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)129-138
Number of pages10
JournalPostgraduate Medicine
Volume126
Issue number7
DOIs
StatePublished - Nov 1 2014

Fingerprint

Practice Guidelines
Chronic Pain
Opioid Analgesics
Guidelines
Analgesia
Drug Monitoring
Primary Care Physicians
Therapeutics
Toxicology
Compliance
Psychiatry
Urine
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2 : best practices. / Cone, Edward J.; DePriest, Anne Z.; Gordon, Allan; Passik, Steven D.

In: Postgraduate Medicine, Vol. 126, No. 7, 01.11.2014, p. 129-138.

Research output: Contribution to journalArticle

Cone, Edward J. ; DePriest, Anne Z. ; Gordon, Allan ; Passik, Steven D. / Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2 : best practices. In: Postgraduate Medicine. 2014 ; Vol. 126, No. 7. pp. 129-138.
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