Ambulatory diagnosis and treatment of non-malignant pain in the United States, 2000–2010

Daubresse, Matthew; Chang, Herng Yu Sucie; Viswanathan, S; Yu, Yifan; Shah, Nilay D.; Stafford, Randall S; Kruszewski, Stefan; Alexander, G. Caleb

doi:10.1016/j.jval.2013.03.615

Cited by 11 publications

(16 citation statements)

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“…In the United States, an estimated 11.2% of the adult population suffers from chronic pain [1] and nearly 20% of patients presenting with acute and chronic non-cancer pain are prescribed opioids [2]. Between 1999 and 2015, opioid prescribing tripled [3] along with the number of deaths attributed to opioid analgesics, with an estimated 17,500 fatalities in 2015 relative to 6160 reported in 1999 [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability

Cooper

Bedi

Ramesh

et al. 2018

Neuropsychopharmacol

125

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Cannabinoids combined with opioids produce synergistic antinociceptive effects, decreasing the lowest effective antinociceptive opioid dose (i.e., opioid-sparing effects) in laboratory animals. Although pain patients report greater analgesia when cannabis is used with opioids, no placebo-controlled studies have assessed the direct effects of opioids combined with cannabis in humans or the impact of the combination on abuse liability. This double-blind, placebo-controlled, within-subject study determined if cannabis enhances the analgesic effects of low dose oxycodone using a validated experimental model of pain and its effects on abuse liability. Healthy cannabis smokers (N = 18) were administered oxycodone (0, 2.5, and 5.0 mg, PO) with smoked cannabis (0.0, 5.6% Δ tetrahydrocannabinol [THC]) and analgesia was assessed using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4 °C); times to report pain (pain threshold) and withdraw the hand from the water (pain tolerance) were recorded. Abuse-related effects were measured and effects of oxycodone on cannabis self-administration were determined. Alone, 5.0 mg oxycodone increased pain threshold and tolerance (p ≤ 0.05). Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance (p ≤ 0.05). Oxycodone did not increase subjective ratings associated with cannabis abuse, nor did it increase cannabis self-administration. However, the combination of 2.5 mg oxycodone and active cannabis produced small, yet significant, increases in oxycodone abuse liability (p ≤ 0.05). Cannabis enhances the analgesic effects of sub-threshold oxycodone, suggesting synergy, without increases in cannabis's abuse liability. These findings support future research into the therapeutic use of opioid-cannabinoid combinations for pain.

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Section: Introductionmentioning

confidence: 99%

Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability

Cooper

Bedi

Ramesh

et al. 2018

Neuropsychopharmacol

125

View full text Add to dashboard Cite

show abstract

“…In the same year, 12.5 million misused pain medications, of which 2.1 million were new misusers of pain medications including adolescents ages 12 through 17 and adults ages 18 and older. The sale of opioids has increased in particular for the management of non-cancer pain, [ 7 , 8 ] and many experts have postulated that there is a correlation between this finding and the increase in opioid overdoses and deaths [ 9 , 10 ]. The current Centers for Disease Control (CDC) recommendation is that all physicians exercise caution while prescribing opioid medications for chronic non-cancer pain that is not palliative or related to end of life care [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Opioid Use Disorders in Adult Postsurgical Patients

Burcher¹,

Suprun²,

Smith³

2018

Cureus

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The use of opioids in the treatment of chronic pain is one of the most controversial topics in medicine today. Many studies have proposed that the postoperative period is a vulnerable time for patients at risk for developing an opioid use disorder. Many patients are prescribed opioids for management of their postsurgical pain and continue using them for prolonged amounts of time following their surgeries. Some populations are more likely to develop an opioid use disorder following exposure to opioid medications than others. In this review, the authors discuss the patient-level risk factors for the abuse of these drugs in postsurgical patients.

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“…The per-capita ingestion of oxycodone in the United States is the highest in the world, almost twice as much as in Canada and between 5-10 times the rates of some similar other countries [8]. Although the number of prescription opioids recently sold has nearly quadrupled, there is no change reported in the degree of pain Americans experience [9][10][11][12].…”

Section: Fatalities Due To Unintentional Opioid Poisoning In the Unitedmentioning

confidence: 99%

Opioid Crisis

Lippmann

2017

Ann Psychiatry Treatm

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Deaths from opioid overdose in the United States doubled between 2000-2014. An increase in prescription opioid drug-induced fatalities parallels a rise in the frequency of these medications being prescribed. Although the number of legal narcotics sold in this country has nearly quadrupled, there is no change reported in the degree of pain Americans experience. Deaths are most common among those opioid users who are drug dependent, even though overdoses occur in medical and non-medical narcotic users who are not addicted.Public health efforts have focused on providing patients with chronic pain appropriate access to opioid pain relievers, while reducing non-medical usage. However, that alone has been insuffi cient to curb opioid overdoses. There remains a high opioid-related morbidity and mortality among people with pain, even for those receiving these analgesics for legitimate clinical reasons. Research results demonstrating the safety and effi cacy of narcotics for chronic, non-cancer pain are not evident. Surveys of patients prescribed opioids over the long-term indicate that most of them continued to experience signifi cant distress; yet, some of them, also experience greater comfort and were without abuse of medication.Physicians should avoid unnecessary opioid prescribing for some people with chronic conditions, although it is diffi cult to predict which patients might be vulnerable to addiction versus who might benefi t from these pharmaceuticals. Because of such uncertainty, it is helpful when doctors screen personal and family histories for substance abuse and provide careful, regular monitoring. Strategies for reducing abuse of prescription analgesic drugs focus on physician prescribing regulations that are thus far not consistently effective.

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Ambulatory diagnosis and treatment of non-malignant pain in the United States, 2000–2010

Cited by 11 publications

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Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability

Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability

Risk Factors for Opioid Use Disorders in Adult Postsurgical Patients

Opioid Crisis

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