Current State of Opioid Therapy and Abuse

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作者：Laxmaiah Manchikanti ; Adam M. Kaye ; Alan D. Kaye
关键词：Chronic opioid therapy ; Opioid abuse ; Opioid adverse consequences ; Opioid deaths ; Opioid overdoses ; Prescription drug monitoring programs (PDMPs) ; Abuse resistance opioids
刊名：Current Pain and Headache Reports
出版年：2016
出版时间：May 2016
年：2016
卷：20
期：5
全文大小：399 KB
参考文献：1.••

Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2015;64:1–5. The Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) provides extensive data on increases in drug and opioid overdose deaths in the United States from 2000 to 2014. The data provides comprehensive information in reference to all aspects of opioid overdose deaths.
2.••

Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson G, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372:241–8. This manuscript provides trends in opioid analgesic abuse and mortality in the United States with a comprehensive look at multiple issues in increasing opioid prescriptions, abuse patterns, resultant mortality, and interrelationship with heroin addiction.
3.•

Atluri S, Sudarshan G, Manchikanti L. Assessment of the trends in medical use and misuse of opioid analgesics from 2004 to 2011. Pain Physician. 2014;17:E119–28. This manuscript provides an up-to-date assessment of trends in medical use and misuse of opioid analgesics from 2004 to 2011, with information illustrating the explosive use of opioids, correlating with emergency room admissions for overdoses and deaths.
4.Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ. 2015;350:g6380.CrossRef PubMed
5.••

Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74. This manuscript provides a comprehensive account of the prescription opioid and heroin crisis along with approaches to combat an epidemic of addiction.
6.Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73:1309–15.CrossRef PubMed
7.US Burden of Disease Collaborators. The state of US health, 1999-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.CrossRef
8.Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968–74.CrossRef PubMed
9.Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13:715–24.CrossRef PubMed
10.Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656-64. Erratum in: JAMA. 2008;299:2630.
11.Cicero TJ, Ellis MS, Harney J. Shifting patterns of prescription opioid and heroin abuse in the United States. N Engl J Med. 2015;373:1789–90.CrossRef PubMed
12.Jones CM, Lurie P, Woodcock J. Addressing prescription opioid overdose: data support a comprehensive policy approach. JAMA. 2014;312:1733–4.CrossRef PubMed
13.Wilder CM, Miller SC, Tiffany E, Winhusen T, Winstanley EL, Stein MD. Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain. J Addict Dis. 2015; [Epub ahead of print].
14.Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. JAMA. 2015;314:1468–78.CrossRef PubMed
15.Werber A, Marschall U, L’hoest H, Hauser W, Moradi B, SChiltenwolf M. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Physician. 2015;18:E323–31.PubMed
16.Weisberg DF, Becker WC, Fiellin DA, Stannard C. Prescription opioid misuse in the United States and the United Kingdom: cautionary lessons. Int J Drug Policy. 2014;25:1124–30.CrossRef PubMed
17.Murphy Y, Goldner EM, Fischer B. Prescription opioid use, harms and interventions in Canada: a review update of new developments and findings since 2010. Pain Physician. 2015;18:E605–14.PubMed
18.•Fischer B, Jones W, Murphy Y, Ialomiteanu A, Rehm J. Recent developments in prescription opioid-related dispensing and harm indicators in Ontario, Canada. Pain Physician. 2015;18:E659–62. This manuscript provides issues related to prescription opioid related dispensing and harms in Ontario, Canada, which seem to parallel the United States.
19.Islam MM, McRae IS, Mazumdar S, Taplin S, McKetin R. Prescription opioid analgesics for pain management in Australia: twenty years of dispensing. Intern Med J. 2015; [Epub ahead of print].
20.••Mehendale AW, Goldman MP, Mehendale RP. Opioid overuse pain syndrome (OOPS): the story of opioids, prometheus unbound. J Opioid Manag. 2013;9:421–38. In this manuscript, the most appropriate term opioid overuse pain syndrome or OOPS has been published to show excessive opioid usage and resultant adverse consequences.
21.Davis JM, Severtson SG, Bucher-Bartelson B, Dart RC. Using poison center exposure calls to predict prescription opioid abuse and misuse-related emergency department visits. Pharmacoepidemiol Drug Saf. 2014;23:18–25.CrossRef PubMed
22.••Chen JH, Humphreys K, Shah NH, Lembke A. Distribution of opioids by different types of Medicare prescribers. JAMA Intern Med. 2015;14:1–3. This manuscript provides distribution of opioids by different types of Medicare prescribers showing detailed data on prescription patterns by various types of physicians discounting the usual philosophy that most prescriptions are given by pain physicians.
23.National Association of Medicaid Directors. State medicaid interventions for preventing prescription drug abuse and overdose: a report for the national association of Medicaid directors. October 1, 2014. www.integration.samhsa.gov/namd_rx_abuse_report_october_2014.pdf .
24.•Toomey, Kaine Call on GAO to review pain clinics’ narcotics dispensing practices. Gov’t watchdog would also examine quality of treatment, patient outcomes. Washington, D.C. December 23, 2015. Senators Toomey and Kaine call the Government Accountability Office to review pain clinics narcotics dispensing practices, without understanding the common prescription patterns by primary care physicians.
25.Lev R, Petro S, Lee A, Lee O, Lucas J, Castillo EM, et al. Methadone related deaths compared to all prescription related deaths. Forensic Sci Int. 2015;257:347–52.CrossRef PubMed
26.Sites BD, Beach ML, Davis MA. Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Reg Anesth Pain Med. 2014;39:6–12.CrossRef PubMed PubMedCentral
27.Fischer B, Keates A, Bühringer G, Reimer J, Rehm J. Non-medical use of prescription opioids and prescription opioid-related harms: why so markedly higher in North America compared to the rest of the world? Addiction. 2014;109:177–81.CrossRef PubMed
28.Martins SS, Sampson L, Cerdá M, Galea S. Worldwide prevalence and trends in unintentional drug overdose: a systematic review of the literature. Am J Public Health. 2015;105:e29–49.CrossRef PubMed PubMedCentral
29.Agarin T, Trescot AM, Agarin A, Lesanics D, Decastro C. Reducing opioid analgesic deaths in America: what health providers can do. Pain Physician. 2015;18:E307–22.PubMed
30.•Manchikanti L, Atluri S, Hansen H, Benyamin RM, Falco FJE, Helm II S, et al. Opioids in chronic noncancer pain: have we reached a boiling point yet? Pain Physician. 2014;17:E1–10. This manuscript describes philosophically current state of opioid therapy in noncancer pain discussing the reaching of the boiling point and measures to curb opioid abuse.
31.Compton WM, Boyle M, Wargo E. Prescription opioid abuse: problems and responses. Prev Med. 2015;80:5–9.CrossRef PubMed
32.Manchikanti L, Hirsch JA. Lessons learned in the abuse of pain relief medication: a focus on health care costs. Expert Rev Neurother. 2013;13:527–44.CrossRef PubMed
33.Manchikanti L, Atluri S, Candido KD, Boswell MV, Simopoulos TT, Grider JS, et al. Zohydro™ approval by Food and Drug Administration: controversial or frightening? Pain Physician. 2014;17:E437–50.PubMed
34.Manchikanti L, Atluri S, Kaye AM, Kaye AD. Hydrocodone bitartrate for chronic pain. Drugs Today. 2015;51:415–27.CrossRef PubMed
35.Volkow ND. America’s addiction to opioids: heroin and prescription drug abuse. Natl Inst Drug Abuse, May 14, 2014. www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse .
36.Express Scripts Lab. A nation in pain: focusing on US opioid trends for treatment of short-term and longer term pain. An Express Scripts Report, December 9, 2014.
37.Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA. 2000;283:1710–4.CrossRef PubMed
38.Gilson AM, Ryan KM, Joranson DE, Dahl JL. A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. J Pain Symptom Manage. 2004;28:176–88.CrossRef PubMed
39.Federation of State Medical Boards of the US. Model guidelines for the use of controlled substances for the treatment of pain: a policy document of the Federation of State Medical Boards of the United States, Inc. Dallas, TX, USA. 1998. www.medsch.wisc.edu/painpolicy/domestic/model.htm .
40.•Fauber J. Painkiller boom fueled by networking. J Sentinel. February 18, 2012. This article by Fauber uncovers numerous conflicts of interest, confluence of interest which fueled the epidemic of opioid prescriptions with numerous parties involved, which also led for improper guidance for physicians to follow through federation of boards of medical licensure.
41.Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, Di Capua P, et al. Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain. Ann Intern Med. 2014;160:38–47.PubMed
42.Pedersen L, Fredheim OMS. Opioids for chronic noncancer pain: still no evidence for superiority of sustained-release opioids. Clin Pharmacol Ther. 2015;97:114–5.CrossRef PubMed
43.Letter to Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, US FDA, from Physicians for Responsible Opioid Prescribing RE Docket No. FDA-2011-D-0771, Draft Blueprint for Prescriber Education for Long-Acting/Extended Release Opioid Class-Wide Risk Evaluation and Mitigation Strategies. December 2, 2011. www.rxreform.org/wp-content/uploads/2011/11/ARPO-Statement-on-FDADraft-Blueprint-112911.pdf .
44.Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:276–86.CrossRef PubMed
45.United States Census Bureau U.S. and World Population Clock. www.census.gov/popclock .
46.Thielke SM, Turner JA, Shortreed SM, Saunders K, Leresche L, Campbell CI, et al. Do patient-perceived pros and cons of opioids predict sustained higher-dose use? Clin J Pain. 2014;30:93–101.PubMed
47.•Manchikanti L, Cash KA, Malla Y, Pampati V, Fellows B. A prospective evaluation of psychotherapeutic and illicit drug use in patients presenting with chronic pain at the time of initial evaluation. Pain Physician. 2013;16:E1–13. This manuscript provides a prospective assessment of patients presenting with chronic pain with assessment of their psychotherapeutic and illicit drug use at the time of initial evaluation.
48.Centers for Medicare and Medicaid Services. New Medicare part D opioid drug mapping tool available. November, 3, 2015. www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-11-03.html .
49.Calcaterra SL, YAhashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2015; [Epub ahead of print].
50.Jena AB, Goldman D, Weaver L, Karaca-Mandic P. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ. 2014;348:g1393.CrossRef PubMed PubMedCentral
51.Morden NE, Munson JC, Colla CH, Skinner JS, Bynum JPW, Zhou W, et al. Prescription opioid use among disabled Medicare beneficiaries: intensity, trends, and regional variation. Med Care. 2014;52:852–9.CrossRef PubMed PubMedCentral
52.Blake H, Leighton P, van der Walt G, Ravenscroft A. Prescribing opioid analgesics for chronic non-malignant pain in general practice—a survey of attitudes and practice. Br J Pain. 2015;9:225–32.CrossRef PubMed PubMedCentral
53.U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. July 9, 2015. www.fda.gov/Drugs/DrugSafety/ucm451800.htm
54.CDC (Cent. Dis. Control Prev.). CDC’s top ten: 5 health achievements in 2013 and 5 health threats in 2014. Atlanta, GA: CDC. 2014. http://blogs.cdc.gov.echo.louisville.edu/cdcworksforyou24-7/2013/12/cdc's-top-ten-5-health-achievements-in-2013-and-5-health-threats-in-2014/ .
55.Centers for Disease Control and Prevention draft CDC guidelines for prescribing opioids for chronic pain. www.cdc.gov/drugoverdose/prescribing/guideline.html
56.Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study opioid prescribing after nonfatal overdose. Ann Intern Med. Published online 29 December 2015.
57.Strassels SA. Economic burden of prescription opioid misuse and abuse. J Manag Care Pharm. 2009;15:556–62.PubMed
58.Roxburgh A, Bruno R, Larance B, Burns L. Prescription of opioid analgesics and related harms in Australia. Med J Aust. 2011;195:280–4.CrossRef PubMed
59.CDC. Vital signs: overdoses of prescription opioid pain relievers and other drugs among women—United States, 1999-2010. MMWR. 2013;62:537–42.
60.Slevin KA, Ashburn MA. Primary care physician opinion survey on FDA opioid risk evaluation and mitigation strategies. J Opioid Manag. 2011;7:109–15.PubMed
61.Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379:55–70.CrossRef PubMed
62.Office of National Drug Control Policy. How illicit drug use affects business and the economy. www.whitehouse.gov/ondcp/ondcp-fact-sheets/how-illicit-drug-use-affects-business-and-the-economy .
63.Angres DH, Bettinardi-Angres K. The disease of addiction: origins, treatment, and recovery. Dis Mon. 2008;54:696–721.CrossRef PubMed
64.Upadhyay J, Maleki N, Potter J, Elman I, Rudrauf D, Knudsen J, et al. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. Brain. 2010;133:2098–114.CrossRef PubMed PubMedCentral
65.Younger JW, Chu LF, D’Arcy NT, Trott KE, Jastrzab LE, Mackey SC. Prescription opioid analgesics rapidly change the human brain. Pain. 2011;152:1803–10.CrossRef PubMed PubMedCentral
66.Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25:171–86.CrossRef PubMed
67.Hser YI, Hoffman V, Grella CE, Anglin MD. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58:503–8.CrossRef PubMed
68.Williams J. Regulation of μ-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol Rev. 2013;65:223–54.CrossRef PubMed PubMedCentral
69.Chou R, Cruciani RA, Fiellin DA, Compton P, Farrar JT, Haigney MC, et al. Methadone safety: a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society. J Pain. 2014;15:321–37.CrossRef PubMed
70.Weimer MB, Chou R. Research gaps on methadone harms and comparative harms: findings from a review of the evidence for an American Pain Society and College on Problems of Drug Dependence clinical practice guideline. J Pain. 2014;15:366–76.CrossRef PubMed
71.Price LC, Wobeter B, Delate T, Kurz D, Shanahan R. Methadone for pain and the risk of adverse cardiac outcomes. J Pain Symptom Manage. 2014;48:333–42.e1.CrossRef PubMed
72.Manchikanti L, Whitfield E, Pallone F. Evolution of the National All Schedules Prescription Electronic Reporting Act (NASPER): a public law for balancing treatment of pain and drug abuse and diversion. Pain Physician. 2005;8:335–47.PubMed
73.Volkow ND. What is the federal government doing to combat the opioid abuse epidemic? Natl Inst Drug Abuse. May 1, 2015. www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/what-federal-government-doing-to-combat-opioid-abuse-epidemic .
74.Garcia AM. State laws regulating prescribing of controlled substances: balancing the public health problems of chronic pain and prescription painkiller abuse and overdose. J Med Ethics. 2013;41 Suppl 1:42–5.CrossRef
75.Cheatle MD. Prescription opioid misuse, abuse, morbidity, and mortality: balancing effective pain management and safety. Pain Med. 2015;16 Suppl 1:S3–8.CrossRef PubMed
76.Cohen V, Motov S, Rockoff B, Smith A, Fromm C, Hossain R, et al. Development of an opioid reduction protocol in an emergency department. Am J Health Syst Pharm. 2015;72:2080–6.CrossRef PubMed
77.Ballantyne JC, Sullivan MD, Kolodny A. Opioid dependence vs addiction: a distinction without a difference? Arch Intern Med. 2012;172:1342–3.CrossRef PubMed
78.Interagency Guideline on Prescribing Opioids for Pain. Washington State Agency Medical Directors’ Group (AMDG) in collaboration with an Expert Advisory Panel, Actively Practicing Providers, Public Stakeholders, and Senior State Officials, 3rd Edition, June 2015. www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf .
79.Fulton-Kehoe D, Sullivan MD, Turner JA, Garg RK, Bauer AM, Wickizer TM, et al. Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines. Med Care. 2015;53:679–85.CrossRef PubMed
80.Sheperd J. Combating the prescription painkiller epidemic: a national prescription drug reporting program. Am J Law Med. 2014;40:85–112.
81.Griggs CA, Weiner SG, Feldman JA. Prescription drug monitoring programs: examining limitations and future approaches. West J Emerg Med. 2015;16:67–70.CrossRef PubMed PubMedCentral
82.Islam MM, McRae IS. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions. BMC Pharmacol Toxicol. 2014;15:46.CrossRef PubMed PubMedCentral
83.Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010;152:712–20.CrossRef PubMed
84.Nguyen V, Raffa RB, Taylor R, Pergolizzi JV. The role of abuse-deterrent formulations in countering opioid misuse and abuse. J Clin Pharm Ther. 2015; [Epub ahead of print].
85.Leece P, Orkin AM, Kahan M. Tamper-resistant drugs cannot solve the opioid crisis. CMAJ. 2015;187:717–8.CrossRef PubMed
86.Larochelle MR, Zhang F, Ross-Degnan D, Wharam JF. Rates of opioid dispensing and overdose after introduction of abuse-deterrent extended-release oxycodone and withdrawal of propoxyphene. JAMA Intern Med. 2015;175:978–87.CrossRef PubMed
87.Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med. 2014;8:153–63.CrossRef PubMed
88.Conermann T, Gosalia AR, Kabazie AJ, Moore C, Miller K, Fetsch M, et al. Utility of oral fluid in compliance monitoring of opioid medications. Pain Physician. 2014;17:63–70.PubMed
89.Fudin J. The perfect storm: opioid risks and “The Holy Trinity.” Pharmacy Times, September 24, 2014. www.pharmacytimes.com/contributor/jeffrey-fudin/2014/09/the-perfect-storm-opioid-risks-and-the-holy-trinity .
90.Courtwright DT. Preventing and treating narcotic addiction—century of federal drug control. N Engl J Med. 2015;373:2095–7.CrossRef PubMed
91.Gasior M, Bond M, Malamut R. Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations. Postgrad Med. 2015 Dec 18:1-12. [Epub ahead of print].
92.Turner JA, Saunders K, Shortreed SM, Rapp SE, Thielke S, LeResche L, et al. Chronic opioid therapy risk reduction initiative: impact on urine drug testing rates and results. J Gen Intern Med. 2014;29:305–11.CrossRef PubMed PubMedCentral
93.Garcia MM, Angelini MC, Thomas T, Lenz K, Jeffrey P. Implementation of an opioid management initiative by a state Medicaid program. J Manag Care Spec Pharm. 2014;20:447–54.PubMed
94.Bird SM, McAuley A, Perry S, Hunter C. Effectiveness of Scotland’s national naloxone programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison. Addiction. 2015; [Epub ahead of print].
95.Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM. Controlled substance prescribing patterns—prescription behavior surveillance system, eight states, 2013. MMWR Surveill Summ. 2015;64:1–14.CrossRef PubMed
96.Imtiaz S, Shield KD, Fischer B, Rehm J. Harms of prescription opioid use in the United States. Subst Abuse Treat Prev Policy. 2014;9:43.CrossRef PubMed PubMedCentral
97.Manchikanti L, Manchukonda R, Damron KS, Brandon D, McManus CD, Cash KA. Does adherence monitoring reduce controlled substance abuse in chronic pain patients? Pain Physician. 2006;9:57–60.PubMed
98.Physicians for Responsible Opioid Prescribing (PROP). www.supportprop.org/ .
99.Cappola AR, FitzGerald GA. Confluence, not conflict of interest: name change necessary. JAMA. 2015;314:1791–2.CrossRef PubMed
100.Manchikanti L, Benyamin RM, Falco FJE, Caraway DL, Datta S, Hirsch JA. Guidelines warfare over interventional techniques: is there a lack of discourse or straw man? Pain Physician. 2012;15:E1–26.PubMed
101.Krasselt M, Häuser W, Petzke F, Baerwald C. S3 guidelines on long-term opioid treatment in non-cancer pain: recommendations for opioid use in clinical rheumatology. Z Rheumatol. 2015; [Epub ahead of print].

作者单位：Laxmaiah Manchikanti (1) (2)
Adam M. Kaye (3)
Alan D. Kaye (4)

1. Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, 42003, USA
2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
3. Department of Pharmacy Practice, University of Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 3601 Pacific Avenue, Stockton, CA, 95211, USA
4. Department of Anesthesia, LSU Health Science Center, 1542 Tulane Ave Room 659, New Orleans, LA, 70112, USA

刊物主题：Pain Medicine; Internal Medicine;

出版者：Springer US

ISSN：1534-3081

文摘

Currently, there is growing tension between the twin challenges of opioid therapy for chronic pain and adverse consequences of abuse, leading to multiple complications including respiratory failure and death. The recent data from Centers for Disease Control and Prevention (CDC) have shown continued escalation of prescription opioid use with opioid overdose deaths topping all previous estimations. Numerous policy initiatives, advisories, and guidelines have been advanced through the years to control the opioid epidemic. The strategies to prevent opioid abuse and to maintain opioid therapy when medically necessary fall into primary and secondary prevention categories. The primary prevention category is extremely crucial, since it involves education of primary care providers and patients at the starting point of opioid therapy. The education of surgeons and other prescribers is as crucial as the education of primary care physicians.

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