__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use • Denver: 7% (never became widespread, now declining)
with complex neurophysiological, emotional, and social components, making its management distinct from that of acute pain [7]. Treating chronic pain differs from acute pain by the duration, multimodal approach, and risk mitigation of the therapy. Clini- cians may fear that managing the issues surrounding opioid analgesic prescribing render the practice too difficult or complex [112]. To assist in the dual need of protecting one’s clinical practice while reducing opioid abuse, the FSMB released a model policy for opioid analgesic prescribing in 2013. This policy was the result of identification of harmful but remedi- able factors contributing to pain undertreatment and inappropriate opioid prescribing, including [10]: • Knowledge gaps in medical standards, current evidence-based outcomes, guidelines for appropriate pain treatment, and regulatory policies • Prescriber concerns that legitimate opioid prescribing will lead to unnecessary scrutiny by regulatory authorities • Conflicting information in existing clinical guidelines • Prescriber concerns of patient deception to obtain drugs for abuse and fears of precipitating addiction Prescribers were held to a standard of safe and best clinical practice, the general points of which include [10]: • Prescribers should know best clinical practices in opioid prescribing, associated risks of opioids, assessment of pain and function, and pain management approaches. Pharmacologic and nonpharmacologic modalities should be used on the basis of current knowledge in the evidence base or best clinical practices. • Pain should be assessed and treated promptly, with therapy selection based on the nature of the pain, treatment response, and patient risk level for developing opioid problems. • Prescribers should use safeguards to minimize misuse and diversion risk of opioid analgesics.
• Indianapolis: 16% (plateau) • Manhattan: 6% (plateau) • Minneapolis: 8% (plateau) • Portland: 15% (plateau, possibly declining) • Sacramento: 12% (plateau) These results illustrate the uneven geographic dis- tribution of the prescription opioid use epidemic. It is also clear that prevalence rates are stabilizing or declining in all localities. These arrestee data indi- cate the epidemic has likely peaked and predict the decline in first-time and past-year use and an increase in prescription opioid addiction and treatment- seeking rates. In susceptible persons, progression in severity of a substance use disorder to addiction often occurs over many years. Persons who now meet diagnostic criteria for opioid analgesic addiction, and may be seeking help, probably began their use during an earlier phase of the epidemic.
MITIGATING RISK IN OPIOID PRESCRIBING PRACTICE
BACKGROUND As discussed, pain treatment, especially in the context of opioid prescribing, is defined as inappro- priate by its non-treatment, inadequate treatment, overtreatment, or continued use of ineffective treat- ment [10]. Inappropriate pain treatment with opioid analgesics elevates the risk of uncontrolled pain, possibly serious adverse side effects, and abuse and diversion. Therefore, clinicians who treat patients with chronic pain are required to use strategies that assess and mitigate the risk of abuse liability inherent in opioids. Although risk assessment and mitiga- tion strategies have been developed to decrease the problem of prescribed opioid abuse, diversion, and overdose, their use can also reduce the development of serious side effects and help ensure the treatment selected is benefiting the patient [112]. The 2011 Institute of Medicine report Relieving Pain in America reinforced the importance of fram- ing chronic pain as a unique chronic disease state
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MDMS1526
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