Opioid Prescriptions: Balancing Misuse or Abuse With Pain Control

This CE activity was originally published in The Rx Consultant.  If you received credit for it previously, you cannot receive credit for it again.

The appropriate and safe management of pain, and concerns about opioid overuse, abuse and overdose, have been making headlines for the past 20 years. Historically, opioids have been used for chronic non-cancer pain despite a lack of high-quality evidence for efficacy. Pain management societies and organizations (eg, THE Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) embraced pain as a “vital sign” in the mid-1990s and encouraged more aggressive use of opioids for chronic pain. The amount of prescription opioids sold in the US increased nearly 4-fold from 1999 to 2014, despite no increase in reported pain.

According to IMS Health, a firm that tracks national prescription statistics, the number of opioid prescriptions dispensed peaked in 2012. For the first time in 20 years, the IMS data indicated a 12% overall decline in US opioid dispensing since the peak. Tightening of federal regulations for opioid prescriptions (eg, moving hydrocodone to schedule II status) likely contributed to the decline. Experts note, however, that the level of prescribing is still very high – with a growing overdose epidemic including fatal overdoses, which reached 28,000 in 2014.

Regulators and the public are looking to clinicians to "do the right thing" regarding pain management, but the "right thing" has been a moving target. What actions are in the patient’s or public’s best interest, and in the best interest of the clinician and their professional practice? There are opposing pressures from 1) patients and pain management experts who advocate providing opioids for individuals with pain, and 2) families, caregivers, and regulatory officials, who want to prevent prescription drug diversion, abuse and overdose. Finding the right balance to provide safe and effective pain management is a “moral imperative,” professional responsibility, and duty of healthcare professionals.