Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions

Passik, Steven D.

doi:10.1016/s0025-6196(11)60748-9

Cited by 120 publications

(67 citation statements)

References 39 publications

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“…It has been proposed that patients be stratified by high, moderate, and low risk for opioid misuse, so that more intensive scrutiny can be placed on those at higher risk [128,129]. However, it is our contention that all chronic pain patients who take prescription opioid pain relievers are at some degree of risk for opioid misuse and abuse and that this risk can change course during physician treatment due to the conditions in the patient's life, such as, emotional well-being,, disease progression, comorbid conditions, mental health conditions, and so on.…”

Section: Discussionmentioning

confidence: 99%

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Dynamic risk factors in the misuse of opioid analgesics

Pergolizzi¹,

Gharibo²,

Passik³

et al. 2012

Journal of Psychosomatic Research

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Section: Discussionmentioning

confidence: 99%

“…The inappropriate use of the prescription opioid agent, whether intentional or unintentional, and regardless of motivation Passik [128] Abuse A maladaptive pattern of prescription opioid use leading to considerable impairment and/or distress Passik [128] Nonmedical use…”

Section: Misusementioning

confidence: 99%

Dynamic risk factors in the misuse of opioid analgesics

Pergolizzi¹,

Gharibo²,

Passik³

et al. 2012

Journal of Psychosomatic Research

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“…In patients identifi ed at higher risk or who demonstrate misuse of opioids, it is possible and prudent to adapt the structure of care to support safe and effective treatment [55]. Some broad elements of structure to consider include the following:…”

Section: Structuring Care To Support Higher-risk Patientsmentioning

confidence: 99%

Management of opioid medications in patients with chronic pain and risk of substance misuse

Savage

2009

Curr Psychiatry Rep

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When prescribed appropriately and used as prescribed, opioid medications can safely and effectively treat pain. Best practices with respect to their use in chronic non-cancer-related pain (CNCP) are evolving. Opioids may be subject to misuse for a variety of purposes, including self-medication, use for reward, compulsive use because of addiction, and diversion for profit. Individuals with chronic pain and co-occurring substance use, mental health disorders, and other conditions may be at increased risk for misuse of prescribed opioids. Interdisciplinary pain management, the use of universal precautions in all patients, and special attention to the structure of care in those at higher risk for opioid misuse may improve outcomes in opioid treatment of CNCP. This article discusses evolving research and clinical literature related to the care of individuals with CNCP at a higher risk for opioid misuse.

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“…5 Among the 4.3 million American patients prescribed opioids, 11 often for CNCP, many present an unfavorable risk-benefit ratio for this treatment. 12 Although noting situations when a taper might be necessary, current guidelines regarding long-term opioid treatment in CNCP, whether published by multidisciplinary expert groups such as the American Pain Society and the American Academy of Pain Medicine, or regulating organizations such as the Federation of State Medical Board, focus on how to prescribe safely and effectively but do not provide practical advice on opioid treatment discontinuation. 13,14 The burden of tapering long-term opioid treatment often falls on community pain practices and individual physician practices, where resources are relatively limited, rather than tertiary centers.…”

Section: Cme Activitymentioning

confidence: 99%

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Berna

Kulich

Rathmell

2015

Mayo Clinic Proceedings

196

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Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

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Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions

Cited by 120 publications

References 39 publications

Dynamic risk factors in the misuse of opioid analgesics

Dynamic risk factors in the misuse of opioid analgesics

Management of opioid medications in patients with chronic pain and risk of substance misuse

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

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