Balancing Benefits and Risks: Opioid Analgesics

The misuse and abuse of extended release and long-acting (ER/LA) opioid medications are urgent public health problems that clinicians who prescribe these drugs can help address by learning safer prescribing, medication management, and patient and family counseling practices.

Opioid pain relievers are the most widely misused and abused controlled prescription drugs and are involved in most unintentional poisoning deaths (1). Such deaths have quadrupled since 1999, and by 2007 outnumbered those involving heroin and cocaine (2). In 2011, nearly 17,000 drug-poisoning deaths in the U.S. involved these medications (3).

Some 34.2 million Americans 12 years of age or older report having used an opioid for non-medical usage at some time in their lives (4) and one in 20 high school seniors reports having abused the prescription medication OxyContin (5).

As the prescribing and use of ER/LA opioids continues to climb, clinicians have a responsibility to learn more about balancing the risks of addiction, abuse and overdose with the benefits of these powerful analgesics in patients suffering from severe chronic pain (6).

“Treating patients with chronic pain is one of the more frustrating experiences in a primary care practice,” said Carol Havens, MD, a family medicine physician and addiction medicine specialist who serves as a CO*RE content development expert. “It’s time-consuming, with a low success rate, and you seem to be constantly balancing on a very thin line between under-treating pain and over-prescribing narcotics.”

Many of our current practices aren’t serving anyone well, Dr. Havens said. “Patients aren’t satisfied, prescribing clinicians are frustrated, and addiction and overdose rates are increasing,” she explained. “We can – and must – do better. It will take a concerted effort, involving all members of the health care team, as well as patients, but we can do it.”

How to learn more

To assist clinician's in learning more, ASAM is working with nine other medical and health care organizations in CO*RE, the Collaborative for REMS Education, to provide educational opportunities. All CO*RE accredited activities fulfill requirements for the ER/LA Opioid REMS (Risk Evaluation and Mitigation Strategies) program established by the Food and Drug Administration.

CO*RE opportunities include an iBook, Medscape activity, live presentations and webinars, online education, and more – all offered free of charge. To download the iBook and other materials, access the Medscape activity, or find upcoming education sessions, visit the CO*RE website [core-rems.org].

Topics covered in CO*RE materials include:

• Assessing patients for treatment with ER/LA opioid analgesics;
• Evaluating potential risks and benefits; and
• Proper methods to initiate therapy, modify dose and discontinue use of opioids.

Evidence-based tools, including patient counseling and informed consent documents, also are available and methods are discussed for counseling patients and caregivers about the safe use of ER/LA opioid analgesics, including proper storage and disposal.

“Being able to address all types of pain across all settings and for diverse populations, while also managing the risk for diversion and misuse, requires a delicate balance,” advised Ron Crossno, MD, a family medicine physician and palliative medicine specialist. “The experts within CO*RE are uniquely suited to provide this information.”