Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ 64 years of age [102]. Approximately 39% involved alcohol and 11% involved illicit drugs [101; 102]. Although an accurate estimate of the number of suicide attempts and completions is unknown because intent is often misclassified or not classified, risk factors for suicidal ideation are very high in the chronic pain population. Many patients with pain experience concurrent depression, and some have histories of alcohol and substance abuse. Multiple studies have shown rates of suicidal ideation and suicide attempts as high as 50% in patients suffer- ing from chronic pain [103]. An estimated 50% of patients with chronic pain have had serious thoughts of committing suicide due to their pain disorder, and drug overdose is the most commonly reported plan for committing suicide (75%) in these patients [104; 105]. The Canadian Community Health Survey found that, after adjusting for sociodemographics and acute mental disorders and comorbidities, the presence of one or more chronic pain conditions significantly elevated the risk of suicidal ideation and suicide attempts [106]. A literature review found that risk of suicide completion was doubled in patients with chronic pain relative to non-pain controls [107]. UNTREATED/UNCONTROLLED PAIN AND MORBIDITY/MORTALITY Mortality Risk that of accidental death from toxicity or overdose with prescribed opioid analgesics. Alterations in Brain Structure and Function Substantial evidence indicates that poorly controlled acute pain can induce neuroplastic changes that underlie the development and perpetuation of chronic pain. Evidence from studies of uncontrolled chronic pain are now documenting changes in brain morphology, such as decreased prefrontal cortex gray matter volume in patients with chronic back pain or fibromyalgia [109]. Diminished prefrontal cortex gray matter volume is associated with adverse functional changes and decreased patient ability to engage in behaviors that can inhibit pain experience [109]. One study compared the brain morpholo- gies of patients with chronic back pain to control subjects, and found 5% to 11% less neocortical gray matter volume among patients with back pain, an association between pain duration and volume reduction, and a loss in gray matter volume equiva- lent to the effects from aging 10 to 20 years [110]. ARRESTEE DATA
Researchers have found a distinctive pattern in the lifespans of drug abuse epidemics. This pattern reflects the escalating and declining prevalence in the use of a substance, the projected course into the near future, and prevalence rate variation across localities. The phases common to all drug epidemics are incubation, expansion, plateau, and decline in use of the drug. Arrestee data are a valuable source of information for tracking drug use trends and are consistent or slightly ahead of drug use data collected from general population studies in measuring drug epidemic phenomenon. To better understand the problem of prescription opioid abuse, information was obtained from 41,501 adult male arrestees in nine geographic locations. Arrestees provided data on their past three-day opioid analgesic use. Data from 2000–2003 were compared with data from 2007–2010. By location, the prescription opioid epidemic phase and the 2010 rate of past three-day opioid analgesic use by arrestees were [111]: • Atlanta: 4% (never became an epidemic) • Charlotte: 8% (plateau, possibly declining) • Chicago: 3% (never became an epidemic)
A link between chronic uncontrolled pain and adverse health outcomes has been identified in previous research, and the results of a 2010 study reaffirmed this association and uncovered a signifi- cant mortality risk not previously identified. Over a 10-year period, a prospective longitudinal study collected annual mortality information from a cohort of 6,940 primary care patients [108]. Survival among those reporting moderate-to-severe interfer- ence from chronic pain was significantly worse than survival among those reporting mild or no chronic pain or interference. After adjusting for sociode- mographic factors and long-term disabling illness, moderate-to-severe chronic pain inflicted a 68% greater mortality risk than cardiovascular disease [108]. While considerable attention has been given to the risk of fatal toxicity and overdose involving opioid analgesics, these data suggest the mortality risk of uncontrolled, severe, chronic pain surpasses
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MDMS1526
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