Treating Pain in Addicted Patients: Recommendations from an Expert Panel

Abstract

Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79-89)

Odnos medicinskih sester do pacienta, odvisnega od prepovedanih drog

“…Manipulacije se največkrat pojavljajo pri oceni pacientove bolečine, kjer pogosto prihaja do nasprotij med oceno medicinske sestre in zahtevami pacientov, odvisnih od prepovedanih drog, po analgetični terapiji (Neville & Roan, 2014). Dokazano je, da z zlorabo opioidov nastanejo poškodbe centra za zaznavo bolečine in da imajo zato uživalci opioidov pomembno znižan prag bolečine (Cheatle, Comer, Wunsch, Skoufalos, & Reddy, 2014). Tako lahko zaključimo, da gre pri pacientih za dejanske nevrofiziološke spremembe, ki se kažejo v tem, da lahko v primerjavi z zdravimi posamezniki izraziteje občutijo bolečino.…”

Positive Toxicology Results Are Not Associated with Emergency Physicians’ Opioid Prescribing Behavior

“…Literature is sparse regarding guidelines on prescribing controlled medications to patients with suspected or confirmed illicit drug use. 20 Previous literature has identified that individuals with alcohol, marijuana, hallucinogen, cocaine, stimulant, heroin, and sedative use disorders, as well as those with nicotine dependence, had a higher prevalence of prescription opioid use disorders. 21 These individuals were also found to have used prescription opioids non-medically more often than those without substance use disorders, with an incidence rate ratio between 1.46 to 1.96.…”

Opioid Use Disorder and Assessment of Patient Interactions Among Family Medicine Residents, Medical Students, and Physician Assistant Students

“…3 Few providers have training to identify the problem of opioid addiction or to use appropriate screening and conduct difficult conversations with patients about addiction and therapy options. [4][5][6] Moreover, in the primary care setting, medication assisted therapy (MAT) is underutilized. 7 Curricula to portray the application of interviewing techniques to approach patients with OUD is imperative to prepare future providers on how to evaluate opioid misuse, addiction, and treatment strategies.…”