Pain Management in an Opioid Epidemic: What’s Appropriate, What’s Safe

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Abuse of prescribed controlled substances—particularly opioid analgesics—and associated morbidity and mortality are a serious public health problem. The response to this crisis must include prevention, early identification, and appropriate treatment of addiction. Prescribing NPs and PAs must understand how to manage acute and chronic pain while also being attentive to signs of drug seeking and opioid misuse and abuse. The information and tools outlined in this article can equip providers to combat the opioid epidemic.

Controlled prescription drug abuse and its associated morbidity and mortality are a serious public health problem globally. In 2015, more than 29 million people worldwide misused and abused drugs, according to the United Nations Office on Drugs and Crime.1 Opioid use disorders account for approximately 70% of that estimate.

In the US, the mortality associated with this abuse has been devastating. Between 1999 and 2014, drug overdose deaths nearly tripled; in 2014 alone, there were 47,055 such fatalities, 61% of which involved opioids.2,3 Since 2000, unintentional overdose deaths from opioids have increased by 200%.3 Overdose deaths associated with natural and semisynthetic opioids (the most commonly prescribed pain relievers) increased 9% from 2013 to 2014, while those associated with synthetic opioids (fentanyl and tramadol) nearly doubled in the same period.3

Further contributing to the problem, a person addicted to prescription opioid drugs is 40 times more likely to be addicted to heroin, compared to someone who is not addicted to opioids.4 Deaths related to heroin overdose continue to dramatically increase.3

A call to action

In August 2016, former US Surgeon General Vivek Murthy, MD, sent a personal letter to more than 2.3 million health care providers, seeking their assistance in addressing the prescription opioid crisis.5 Murthy acknowledged the challenges providers face when attempting to strike a balance between treating a patient’s pain and reducing the risk for opioid addiction. He explained that clinicians are uniquely situated to end this crisis, and he asked providers to pledge to “turn the tide” by taking three actions

  • Become more educated about treating pain safely and effectively.
  • Screen patients for opioid use disorder and make the appropriate evidence-based treatment referrals.
  • Discuss and treat addiction as a chronic disorder.5

To help stem the epidemic of controlled prescription drug abuse, NPs and PAs must be knowledgeable about patient safety issues, including how to identify patients at risk for opioid misuse and recognize signs of misuse or abuse. This article aims to educate providers who have prescriptive authority about the pharmacology of opioids; safe and effective prescribing of these drugs; and how to identify and manage misuse and abuse.


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