Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

“…It is therefore important that clinicians consider the risk of opioid addiction without this prejudicing their use where indicated. In fact, those who use opioids constitute a heterogeneous category that includes extreme cases of patients who abuse medical and non-medical substances, and patients who adhere to treatment (Passik, 2009). For adequate management and treatment of pain, physicians must balance the costs and benefits of opioid treatment; to maximise the benefits they can use different strategies, such as risk assessment and stratification, using specific tools, constant monitoring of treatment and any aberrant drug behaviours, regular urine screening and the possible involvement of another specialist (e.g.…”

Prescription Opioid Medications: Efficacy in Chronic Pain

“…Despite large numbers of such patients, the diagnosis and treatment of alcohol-and drug-related disorders are generally considered peripheral to or outside medical matters and ultimately outside medical education. There is substantial evidence that physicians fail even to identify a large percentage of patients with these disorders [72,73].…”

Contemporary Clinical Opioid Use: Opportunities and Challenges

“…In the hands of anesthesiologists or other highly trained clinicians, such adverse effects are anticipated, mitigated, and prevented. However, in the hands of those with inadequate pharmacological knowledge, unfortunate opioid events can occur to individual patients [3][4][5] or practitioners 6,7 and en masse. 16 In 2002 when Russian troops attempted to immobilize 50 Chechnyan rebels and their 800 hostages inside a Moscow theater, the troops allegedly used an aerosolized potent opioid (presumably carfentanil or a related drug) as a mass "calmative"; 127 (16%) of the hostages died, and others became critically ill.…”

“…Concurrent with the introduction of fentanyl and other novel opioids, laboratory-based investigators began exploring the receptors responsible for opioid effects and discovered a veritable treasure trove (eg, delta, kappa, mu) of receptor subtypes. As reviewed in part by the aforementioned authors in this issue of the Proceedings, the new opioid agonists vary greatly in duration (ranging from long-acting drugs such as methadone, which lasts hours to days, 3,4 to remifentanil, with a duration of only a few minutes), potency, receptor selectivity, and clinical application.…”

“…Because of its long half-life and duration of effect, methadone also is a highly effective, and an increasingly used, first-line drug in treating acute, chronic, neuropathic, and cancer pain and as an alternative to morphine and other firstline opioids. 3,4 It is cost-effective at less than $0.25 per dose (pharmacy cost) compared to more than $8 per dose for some sustained-release opioids. Unfortunately, coincident with the intensified focus on adequate pain treatment (specifically that involving methadone) and increased administration of pain therapies by primary care professionals, methadone-related deaths have increased considerably.…”