Block 9 - L7 Flashcards
What is the prevalence of chronic pain in the US?
11.2%
What percent of the adult US population is prescribed long-term opioids?
3-4%
What are the most common opioid medications associated with overdose?
- Methadone
- Oxycodone
- Hydrocodone
What are some of the factors contributing to the development of the opioid epidemic?
- Concerns about under-treatment of pain
- Introduction of pain as the 5th vital sign
- Influential articles suggesting that opioids were effective for chronic pain with low risk of addiction
- Easy access (friends, relatives, physicians)
True or false - the evidence of long-term efficacy of opioids for chronic pain is limited.
True
Generally, what are the preferred therapies for chronic pain?
Non-pharmacologic and non-opioid pharmacologic therapies
How can a provider review a patient’s history of controlled substance prescriptions?
State prescription drug monitoring programs
Providers should avoid prescribing opioids with ___.
Benzodiazepines
Which populations are at a higher risk for abusing opioids?
- People with a history of substance use disorder or mental illness (especially MDD)
- Caucasian
- Age 18-30
- Living in rural areas
- Low income
- History of opioid OD
What drug-related risk factors predispose someone to abuse opioids?
- Higher opioids dosages
- High dose, short-acting medications
- Experiencing opioids as rewarding
- Opioid craving
- Concurrent benzodiazepine use
- Prescriptions from multiple providers
What are red flag behaviors that might indicate someone is abusing opioids?
- Prescriptions from multiple providers for opioids and benzodiazepines
- Requesting specific medications
- Focus on medication and not on pain
- Refusal for consent for collateral information
- Running out early
- Going to ED to fill prescriptions
- Reporting lost or stolen prescriptions
- Clinical intoxication with use (slurred speech, dizziness, falls, confusion)
What are opioids indicated for?
Active cancer, palliative care, and end-of-life care; short-term use for chronic pain
What should be done when initiating an opioid prescription?
- Controlled substances contract
- UDS for baseline
- Review patient’s history with a prescription monitoring program
- Mitigate risk (prescribe only immediate-release opioids, avoid liberal dosing)
- Adjunctive treatment with non-pharmacologic treatments (CBT, exercise, interventional treatments, multimodal pain treatment)
What should be done when maintaining treatment with opioids?
- Evaluate benefits vs. risks every 3 months
- Check prescription monitoring programs every 3 months
- If increasing beyond 50 MME, evaluate risks/benefits carefully
- Avoid concurrent benzodiazepines
- Check UDS at least annually
- If using chronically, offer naloxone OD reversal kit
- Stay focused on functioning
What should be done when discontinuing opioids?
- Decide when to discontinue
- Switch to immediate-release
- Avoid using MME charts to go from one medication to another
- Manage withdrawal symptoms
- Offer evidence based treatment
