__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use False conclusions of a cause-effect relationship may also occur when data used in support of a conclusion come from small but statistically significant out- comes in a measure of effect, when broader examina- tion of the data suggests otherwise. One example is the conclusion of a cause-effect relationship between higher methadone dose and frequency of the serious adverse cardiac event of QTc interval prolongation. The basis of this conclusion of causality was the find- ing of a modest yet statistically significant correlation between higher dose and adverse event [220; 221]. However, the conclusion is false because correlation does not equate with causality, and a closer look at the actual data revealed that increased QT interval occurred only in the subgroup who were abusing cocaine, a drug with well-known cardiotoxic effects. Post Hoc Fallacy This study was criticized for using a post hoc , ergo propter hoc argument as the basis for causation in a commentary published in the same journal issue [223]. The commentary noted that just because patients improved after midazolam treatment did not mean they improved because of midazolam treatment. From an evidence-based perspective, the study evidence would also be regarded as low quality because it lacked a control group and the open-label design did not control for placebo response. Differences in Definitions
Differences in definitions also represent a serious confounding factor. Opioid “misuse” may describe overuse or underuse for medical purposes, non- medical use, or diversion, and may be a one-time occurrence or more frequent. There is little clarity or consistency across studies in how this variable is defined and measured. Consequently, the preva- lence rate of opioid misuse can be expressed as a large or small probability depending on the study biases. This same phenomenon occurs with many other variables studied in pain management and an be very misleading to consumers of research.
An example of post hoc fallacy in reasoning comes from a prospective, observational, open-label study in which single-dose intrathecal midazolam was used in patients with failed back surgery syndrome. The patients showed significant pain reduction and few side effects, and the researchers concluded that single-dose intrathecal midazolam was an effective supplement to standard analgesic therapy [222].
WORKS CITED https://qr2.mobi/Opioid-Risk
F INAL E XAM PRESCRIPTION OPIOIDS: RISK MANAGEMENT AND STRATEGIES FOR SAFE USE Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 59, or complete your test online at BOOK.CME.EDU. A passing grade of at least 70% must be achieved in order to receive credit for this course.
The fifth revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) categorizes prescription opioid addiction as A) tolerance. B) substance abuse.
2.
1.
Inappropriate opioid analgesic prescribing is defined as A) non-prescribing. B) inadequate prescribing. C) continued prescribing after evidence of ineffectiveness. D) All of the above
C) substance dependence. D) substance use disorder.
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MDMS1526
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