Opioid Prescriptions for Chronic Pain and Overdose

  title={Opioid Prescriptions for Chronic Pain and Overdose},
  author={Kate M. Dunn and Kathleen Saunders and Carolyn M. Rutter and Caleb J. Banta-Green and Joseph O. Merrill and Mark D. Sullivan and Constance Weisner and Michael J. Silverberg and Cynthia I. Campbell and Bruce M. Psaty and Michael Von Korff},
  journal={Annals of Internal Medicine},
  pages={85 - 92}
BACKGROUND Long-term opioid therapy for chronic noncancer pain is becoming increasingly common in community practice. Concomitant with this change in practice, rates of fatal opioid overdose have increased. The extent to which overdose risks are elevated among patients receiving medically prescribed long-term opioid therapy is unknown. OBJECTIVE To estimate rates of opioid overdose and their association with an average prescribed daily opioid dose among patients receiving medically prescribed… 

Association between opioid prescribing patterns and opioid overdose-related deaths.

Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death, and receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment.

Opioid dose and drug-related mortality in patients with nonmalignant pain.

Among patients receiving opioids for nonmalignant pain, the daily dose is strongly associated with opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines.

Care management practices for chronic pain in veterans prescribed high doses of opioid medications.

Patients in the high-dose group had several aspects of documented care that differed from patients in the traditional dose group, including more medical visits, attempting an opioid taper, receiving a urine drug screen and developing a pain goal.

A chronic opioid therapy dose reduction policy in primary care.

A combined intervention of education and a practice policy that limits opioid doses for patients prescribed chronic opioid therapy may be an important component of system-level strategies to reduce opioid misuse and overdose; it may also help identify patients suitable for medication-assisted treatment for opioid use disorder.

Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain

Established SOAPP-R and DSM thresholds provide an opportunity to identify participants at elevated risk for having experienced an opioid overdose, and data support development of additional concentrated efforts to prevent overdose among chronic pain patients.

Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose

This study sought to characterize opioid use after an overdose among patients receiving long-term opioid therapy for noncancer pain among patients from a large U.S. health insurer with members in all 50 states.

Prescription opioid duration of action and the risk of unintentional overdose among patients receiving opioid therapy.

The findings of the present study provide the first evidence that the risk of unintentional overdose injury is related to the prescribed opioid's duration of action, and suggest that clinicians weighing the benefits and risks of initiating different opioid regimens should consider not only the daily dose prescribed but also the duration of opioid action, favoring short-acting agents whenever possible, especially during the first 2 weeks of therapy.

Opioid therapy for chronic pain in the United States: Promises and perils




De Facto Long-term Opioid Therapy for Noncancer Pain

The proposed threshold for long-term opioid therapy provides a checkpoint for physicians to review whether an explicit decision to sustain opioid therapy has been reached, and to ensure that a documented treatment plan and provisions for monitoring medication use and patient outcomes are in place.

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

Efficacy of Opioids for Chronic Pain: A Review of the Evidence

It is concluded that existing evidence suggests that analgesic efficacy, although initially good, is not always sustained during continuous and long-term opioid therapy (months to years).

Relationship Between Early Opioid Prescribing for Acute Occupational Low Back Pain and Disability Duration, Medical Costs, Subsequent Surgery and Late Opioid Use

It is suggested that the use of opioids for the management of acute LBP may be counterproductive to recovery, and the associations between early opioids and outcomes were evaluated using multivariate linear and logistic regression models.

Rates of Adverse Events of Long-Acting Opioids in a State Medicaid Program

A modest safety advantage is supported with ER oxycodone compared with ER morphine among patients newly prescribed an LAO and among subjects with noncancer pain, fentanyl and methadone were associated with an increased risk of an adverse event compared withER morphine.

Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction

Context Patients with low back pain often request pain medication, and many physicians prescribe opioids despite concerns about drug dependence. Contribution Opioid prescribing rates in 11 studies

Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002.

Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain, and it is possible that tolerance or opioid-induced abnormal pain sensitivity may be occurring in some workers who use opioids for chronicPain.

Opioid analgesia: perspectives on right use and utility.

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Weak and strong opioids outperformed placebo for pain and function in all types of CNCP and were significantly superior to naproxen and nortriptyline, and only for pain relief.