Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies — NEJM – Nora D. Volkow, M.D. [Director of the National Institute on Drug Abuse (NIDA)], and A. Thomas McLellan, Ph.D. – Mar 2016 – free full-text article
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage.
The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction
Here, we draw on recent research to address common misconceptions regarding the abuse-related risks of opioid analgesics and highlight strategies to minimize those risks. Continue reading
Opioid overdoses are climbing. But prescription painkillers aren’t driving them anymore. – Vox – by firstname.lastname@example.org Apr 1, 2017,
The crackdown on opioid prescriptions to rein in the raging epidemic of opioid abuse and overdoses is picking up steam.
Ten states have passed legislation that limits new opioid prescriptions to 10 days or less (in line with 2016 Centers for Diseases Control and Prevention guidelines), and more states are likely to follow suit.
But as prescriptions for oxycodone and morphine get more restrictive, opioids sold on the black market are eclipsing them as a bigger threat, at least when it comes to overdoses. Continue reading
The Fallacy of the Gateway Drug Theory – Pain Medicine News – Dec 2016 – by Lynn R. Webster, MD
In 2012, Vanyukov et al published an article describing two separate views on the role that drugs play in initiating an addiction.
- One is the “gateway theory” and the
- other is the “common liability to addiction concept.”
The gateway theory places the drug as the primary factor in initiating a substance use disorder (SUD).
The belief is that exposure to a licit rewarding drug (e.g., tobacco, prescription opioid) begins a developmental process that progresses like a disease to a more serious stage, culminating in the use of an illicit drug (e.g., marijuana, heroin). Thus, in this theory, exposure to a drug initiates an SUD independent of the biology of the individual. Continue reading
Reply to Study of Rx Drug Monitoring Programs – Health Affairs – June 2016 – David L. Evans, Nurse Practitioner
I’m encouraged by this professional’s response to yet another study about opioid prescribing that refuses to acknowledge that none of these restrictive policies are diminishing overdoses.
More money is still being spent on creating and studying methods to reduce opioid prescribing, which only serves to deflect our attention from the real problem, which is the increasing rate of addiction in America.
It seems blatantly obvious that to decrease overdoses, we must decrease addiction. Continue reading
The Fallacy of the Gateway Drug Theory – Pain Medicine News – Dec 14, 2016 by Lynn R. Webster, MD
In 2012, Vanyukov et al published an article describing two separate views on the role that drugs play in initiating an addiction (Drug Alcohol Depend 2012;123:S3-S17).
One is the “gateway theory” and the other is the “common liability to addiction concept.”
The gateway theory places the drug as the primary factor in initiating a substance use disorder (SUD). The belief is that exposure to a licit rewarding drug (e.g., tobacco, prescription opioid) begins a developmental process that progresses like a disease to a more serious stage, culminating in the use of an illicit drug (e.g., marijuana, heroin).
Thus, in this theory, exposure to a drug initiates an SUD independent of the biology of the individual. Continue reading
Long-term opioid management for chronic noncancer pain. – PubMed – NCBI – Cochrane Database Syst Rev. 2010 Jan 2
Opioid therapy for chronic noncancer pain (CNCP) is controversial due to concerns regarding long-term effectiveness and safety, particularly the risk of tolerance, dependence, or abuse.
OBJECTIVES: To assess safety, efficacy, and effectiveness of opioids taken long-term for CNCP.
SEARCH STRATEGY: We searched 10 bibliographic databases up to May 2009. Continue reading
Expert Feedback on the Surgeon General’s Report on Addiction – December 02, 2016
Clinical Pain Advisor talked to Stefan Kertesz, MD, a physician and Associate Professor at the University of Alabama at Birmingham School of Medicine, to get his feedback regarding the anticipated impact of the Surgeon Generals’ report.
- Clinical Pain Advisor (CPA): How do you think the Surgeon General’s report will help address the prescription opioid epidemic?
Dr Kertesz: I think it may begin to set the stage to help us with this epidemic, because the report tries to show how addiction is a complex disorder that emerges in each person and community, based on a range of personal and community factors…it shows that the causes of addiction are complex, and that it is not simply a matter of getting exposed to a drug Continue reading
Pain vs. Addiction Behavior – by Celeste Cooper
Use or Abuse: Two Sides of the Same Coin
The following are examples of behavioral differences between those living with chronic pain, and those living with addiction.
Both can be life altering and both deserve appropriate care.
Ms. Cooper distills the differences into 7 factors, which show the diametrically opposed stances of addicted people and pain patients. Continue reading
Study: Assess Abuse Potential of Drugs in Pain Patients, Not Misusers – Pain Medicine News – Nov 2016
New research suggests that the abuse potential of opioid analgesics should be explored in pain patients rather than in “recreational users,” as specified in the FDA’s “Guidance for Industry: Assessment of Abuse Potential of Drugs.”
“Abuse potential in recreational users is important information,” Dr. Alfieri and his colleagues indicated in their findings. “However, opioids are labeled for the treatment of pain.
Therefore, understanding the abuse potential among chronic pain patients who are not recreational opioid users (target population) would advance pain treatment.” Continue reading
Are alcoholism treatments effective? The Project MATCH data | BMC Public Health | Full Text
Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered. The zero treatment dropout group showed great improvement, achieving a mean of 72 percent days abstinent at follow-up
Effect size estimates showed that two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero treatment group.
Outcomes for the one session treatment group were worse than for the zero treatment group, suggesting a patient self selection effect Continue reading