Overview of Opioid Toxicity and Risks
- Credit Type
- AMA
- Credit Amount
- 0.5
- Release Date
- 07/01/2011
- Expiration Date
- 07/01/2012
- Activity Type
- Webcast
Activity Goal
This educational activity provides an overview of the risks associated with opioid pharmacotherapy.
Intended Audience
Pain specialists, anesthesiologists, physiatrists, neurologists, palliative care specialists, primary care physicians, nurse practitioners, pharmacists, allied health professionals, fellows, and residents.
Needs Assessment and Learner’s Gap
Opioid pharmacotherapy is associated with several side effects, all of which require careful assessment to maintain patient adherence. For example, constipation occurs in approximately 40% of patients receiving opioid medications.1 While laxatives are routinely used to treat this side effect, there are few studies to guide clinical practice. Peripheral opioid antagonists may be useful in patients who do not adequately respond to laxatives. Nausea or vomiting are common and often self limiting side effects that can be treated with antiemetic therapies.2 Somnolence and mental clouding frequently occur as well and can be treated with psychostimulants.3,4 Careful dose titration, too, can increase tolerability. Less common, but potentially serious, risks of opioid therapy include sleep-disordered breathing, neuroendocrine effects, and QTc prolongation.5-7 Clinicians should actively anticipate and treat opioid-associated adverse effects.
References
- Pappagallo M. Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg. 2001;182(5A suppl):11S-18S.
- Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-130.
- Reissig JE, Rybarczyk AM. Pharmacologic treatment of opioid-induced sedation in chronic pain. Ann Pharmacother. 2005;39(4):727-31.
- McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4:231-256.
- Webster LR, Choi Y, Desai H, Webster L, Grant BJ. Sleep-disordered breathing and chronic opioid therapy. Pain Med. 2008;9(4):425-32.
- Abs R, Verhelst J, Maeyaert J, et al. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000;85(6):2215-2222.
- Keller GA, Ponte ML, Di Girolamo G. Other drugs acting on nervous system associated with QT-interval prolongation. Curr Drug Saf. 2010;5(1):105-111.
Learning Objectives
At the conclusion of this presentation, you will be able to:
- Recognize opioid-related side effects in patients with chronic pain.
- Titrate opioid medications as needed to achieve a balance between opioid analgesia and side effects.
- Manage constipation, nausea, somnolence, and other opioid-associated side effects commonly observed in patients with chronic pain.
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Beth Israel Medical Center, St. Luke’s & Roosevelt Hospitals, and Asante Communications, LLC. Beth Israel Medical Center and St. Luke’s & Roosevelt Hospitals are accredited by the ACCME to provide continuing medical education for physicians.
Faculty Disclosure
Russell K. Portenoy, MD has served as a consultant for Afferent Pharmaceuticals, Inc., Ameritox, Cephalon, CNSBio, Grupo Ferrer, King Pharmaceuticals, Nicox, ProStrakan Pharmaceuticals, Purdue Pharma, Shire Pharmaceuticals, Solvay, Wyeth and Xenon Pharmaceuticals; he has received research grants (to the Department of Pain Medicine and Palliative Care) from Archimedes Pharmaceuticals, Baxter Healthcare Corporation, Calloway Labs, Cephalon, Endo Pharmaceuticals, Flamek Corporation, Fralex, GW Pharmaceuticals, King Pharma, Pfizer, Inc., Purdue, Tempur-Pedic Corporation, United BioSource Corp, and Wyeth.
Credit Designation
Credit Designation designates this Internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity. Prior to viewing the webcasts, each participant must read the learning objectives and acknowledge receipt of the CME information. Additionally, each participant must also complete a prequestionnaire before beginning the activity. Upon completion of this prequestionnaire, the activity will commence. Once the final webcast is viewed, credit may be obtained by completing the posttest, program evaluation, and the attestation statement. Credit is available through July 1, 2012.
Copyright Information
As herein stated, the term "Continuum Affiliates" means Beth Israel Medical Center, St. Luke's-Roosevelt Hospital Center, Long Island College Hospital, and the New York Eye & Ear Infirmary. Continuum Health Partners, Inc. is the parent company of each of the Continuum Affiliates.
Unless otherwise stated, the contents of this activity are copyrighted as a collective work under the laws of the United States and other copyright laws by Continuum Health Partners, Inc., all rights reserved. The collective work may include works that are the property of other authors and that are also protected by copyright and other intellectual property laws. Any redistribution, retransmission, or publication of any copyrighted material is strictly prohibited without the express written consent of Continuum Health Partners, Inc. and all other copyright owners.
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Faculty
