Curtailing Diversion and Abuse of Opioid Analgesics Without Jeopardizing Pain Treatment

National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2011; 305(13):1346-7. DOI: 10.1001/jama.2011.369
Source: PubMed
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    • "For example, previously-reported comparisons of primary PO and heroin abusers have noted that PO abusers experienced less severe withdrawal during buprenorphine induction, provided more opioid-negative urine samples during a buprenorphine taper, were more likely to be retained in a buprenorphine taper, and were more likely to be opioid-negative at the end of a buprenorphine taper, compared to primary heroin abusers (Nielsen et al., 2012, 2013, 2014). Finally, the recent increases in adolescent opioid abuse warrant exploring potential alternatives to long-term maintenance (Zacny et al., 2003; McLellan and Turner, 2008; Volkow and McLellan, 2011), particularly given evidence that long-term opioid maintenance may alter cognitive functions (Gruber et al., 2007). When considering the available pharmacotherapies for use in opioid detoxification, the partial mu-opioid agonist buprenorphine has a pharmacological profile that lends toward its use in taper regimens. "

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    • "In Indiana, counties with higher rates of dentists and pharmacists had more per capita opioid prescriptions. While it is true that primary care physicians and internists write the most prescriptions for opioids (Governale, 2010; Volkow et al., 2011), other research has demonstrated that dentists are a significant source of opioid prescriptions (Volkow et al., 2011). Our findings regarding pharmacists further reinforce the need to think more systemically about the problem as the accessibility and abuse of "
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    ABSTRACT: Background Opioid use and abuse in the United States continues to expand at an alarming rate. In this study, we examine the county-level determinants of the availability and abuse of prescription opioids to better understand the socio-ecological context, and in particular the role of the healthcare delivery system, on the prescription drug abuse epidemic. Methods. We use community-level information, data from Indiana's prescription drug monitoring program in 2011, and geospatial regression methods to identify county-level correlates of the availability and abuse of prescription opioids among Indiana's 92 counties. Results. The findings suggest that access to healthcare generally, and to dentists and pharmacists in particular, increases the availability of prescription opioids in communities, which, in turn, is associated with higher rates of opioid abuse. Conclusions. The results suggest that the structure of the local healthcare system is a major determinant of community-level access to opioids adding to a growing body of evidence that the problem of prescription opioid abuse is, at least in part, an “iatrogenic epidemic.”
    Drug and alcohol dependence 05/2014; 138(1). DOI:10.1016/j.drugalcdep.2014.03.002 · 3.42 Impact Factor
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    • "[80]. Finally, the literature has shown that opioid overdose is the second leading cause of unintentional death in the U.S. [81], while the estimated total healthcare costs attributed to prescription opioid abuse are estimated at US $25.0 billion [82]. "
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    ABSTRACT: Chronic non-cancer pain is a debilitating condition associated with high individual and societal costs. While opioid treatment for pain has been available for centuries, it is associated with high variability in outcome, and a considerable proportion of patients is unable to attain relief from symptoms while suffering adverse events and developing medication dependence. We performed a review of the efficacy of pharmacogenomic markers and their abilities to predict adverse events, dependence, and associated economic costs, focusing on two genes: OPRM1 and CYP2D6. Data sources were articles indexed by PubMed on or before August 6, 2013. Articles were first selected after review of their titles and abstracts, and full papers were read to confirm eligibility. Initially, fifty-two articles were identified. Of these, 17 were relevant to biological actions of pharmacogenomic markers and their effect on therapeutic efficacy, 16 to adverse events, 15 to opioid dependence, and eight to economic costs. In conclusion, increasing costs of opioid therapy have made the advances in pharmacogenomics an attractive solution to personalize care with unclear repercussions related to the impact on costs, morbidity, and outcomes. This intersection of pharmacoeconomics and pharmacogenomics presents a unique platform to further examine current advances in clinical medicine and their utility in cost-effective treatment of chronic pain.
    Pain Research and Treatment 09/2013; 2013:943014. DOI:10.1155/2013/943014
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