Prescribing Opioids for Pain: Challenges and Solutions
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This educational activity addresses strategies that can help clinicians recognize aberrant behaviors, tailor opioid therapy consistent with the risk of nonmedical opioid use, and reduce the misuse, abuse, and diversion of opioid analgesics.
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
Patients with chronic pain who receive opioid pharmacotherapy should be, according to recently published American Pain Society (APS)/American Academy of Pain Medicine (AAPM) guidelines, continually monitored for potentially aberrant medication behaviors.1,2,3 Comprehensive assessment includes a careful patient history and use of screening tools such as the Opioid Risk Tool (ORT). The level of monitoring, in turn, is tailored to each patient’s risk of nonmedical opioid use. Safe use of opioids warrants patient education on the risks and benefits of treatment, urine drug screening (although results require careful interpretation), and regular office visits to monitor patient progress. Patient adherence to opioid regimens can be monitored with routine pill counts and, in an increasing number of states, with statewide prescription monitoring programs. Finally, while aberrant medication behaviors are common, opioid addiction is not. When addiction occurs, clinicians should consider opioid discontinuation, transition to opioid antagonists, and referral to an addiction management program.
- Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician. 2010;13:401-435.
- Webster, LR, and Webster, RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6:432-442.
- 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.
At the conclusion of this presentation, you will be able to:
- Identify risk factors associated with opioid misuse, abuse, and diversion.
- Evaluate adherence to opioid therapy with pill counts, urine drug screening, and treatment monitoring programs.
- Structure opioid therapy commensurate with the patient-specific risk of nonmedical opioid use.
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.
Marc N. Gourevitch, MD, MPH has reported that he does not have any financial relationships to disclose.
Joanna L. Starrels, MD, MS has reported that she does not have any financial relationships to disclose.
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.
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.
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