Mitigating the dangers of opioids.
نویسنده
چکیده
JAMA InternalMedicinehas run a series of articles on thedangersofprescriptionopioids for the treatmentof chronicpain.1,2 Thebest solution is toavoidprescribingopioids forchronicpain because there is no high-quality evidence that they are effective for this indication, and the risk of adverse effects, including death from unintentional overdose, is great.3 But whenpatientsare inpain, andnonopioidmethodshaveproven ineffective, it can be difficult to send patients out of the office without an opioid prescription. Therefore, it is important to identify strategies to mitigate thedangers of opioids. In that regard, the article byMiller et al,4 is important because it demonstrates that there is less danger toprescribing short-acting rather than long-actingopioids.Amongapopulationof veteranswith chronic pain, using pharmacy and administrative data and a propensity score to adjust for baseline differences, the authors found that the risk of unintentional overdose was more than twice as high among patients initiating long-acting vs short-acting prescription opioids. The risk of overdose was more than 5 times higher in the first 2 weeks following initiation of longacting opioid therapy. Although it is possible that the higher rate of unintentional overdose among those veterans who received longacting agents is due to confounding from some unmeasured variable, itwouldbewise toavoid long-actingagentswhen initiating opioid therapy for chronic pain. It is also important to avoid high doses of opioids.1 Meanwhile, there is an urgent need for better nonopioid treatments for chronic pain.
منابع مشابه
A protocol for addressing acute pain and prescribing opioids.
Physicians across the country are re-examining their role in the prescription opioid abuse problem. In response to growing public awareness about the dangers of opioids, the Minnesota Medical Association formed a Prescription Opioid Management Advisory Task Force. As part of its work, the task force partnered with the Institute for Clinical Systems Improvement (ICSI) to develop a protocol for p...
متن کاملAnti-in ammatory effects of k-opioids: relevance to rheumatoid arthritis
Opioid drugs are not currently used in the treatment of rheumatoid arthritis, partly because of their range of side effects and because their antiinammatory (as opposed to analgesic) actions have been largely unrecognized. The synthesis of peripherally selective k-opioid agonists has allowed the analgesic and anti-inammatory effects of opioids in arthritis to be studied, while mitigating the ...
متن کاملThe importance of opioid tolerance: a therapeutic paradox.
Surgeons appreciate that a responsibility to manage pain is an integral part of their practice. Multiple treatment modalities for optimally managing pain are frequently necessary, but knowledgeable use of analgesic drugs is the most essential because drug therapy is the mainstay of pain treatment. The most important analgesic drug group to understand is the opioids. Opioids are potent, versatil...
متن کاملTime series analysis of California's prescription monitoring program: impact on prescribing and multiple provider episodes.
UNLABELLED Prescription monitoring programs (PMPs) are designed to reduce medication diversion by identifying individuals obtaining the same medication from multiple providers (termed multiple provider episodes [MPEs]). This study determined whether recent changes to California's PMP influenced: 1) the extent that practitioners issue prescriptions for a variety of Schedule II opioids; and 2) th...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- JAMA internal medicine
دوره 175 4 شماره
صفحات -
تاریخ انتشار 2015