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 Opioid therapy is a cornerstone of severe acute and moderate-to-severe chronic pain management. Yet, resistance to opioid use can be a significant barrier to effective therapy.
Often, concerns about the perceived adverse effects and addictive properties of opioids, and/or regulatory scrutiny, cause these medications to be underused. Documents in this tab section address those concerns and help dispell the many misunderstandings.
 Also see the following sections for additional documents of interest:
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 = entry added or changed during the latest update.
 = Pain Treatment Topics exclusive document.
 OPIOID Rx & Safety [General]
This section focuses on dispelling the myths surrounding opioid analgesics. Clinical guidance is provided for more effective application and prescribing of these vital pain medications, with a special emphasis on safety issues to prevent or manage adverse events.
 View all details listings <Click Here> or select item below...
 Patients Who Require Ultra-High Opioid Doses
By: Schneider J, Anderson A, Tennant F. PPM. 2009(Sep);9(7):10+.
See details...>
Opioid Metabolism
By: Howard S. Smith, MD. Mayo Clinic Proceedings. 2009(July).
See details…>
A Comparison of Long- and Short-Acting Opioids for Chronic Noncancer Pain
By: Charles E. Argoff, MD and Daniel I. Silvershein, MD. Mayo Clinic Proceedings. 2009(July). See details…>
Opioid Pharmacology
By: Andrea M. Trescot, MD, et al. Pain Physician. 2008(March);11: S133-S153. See details…>
A Practical Guide for Prescribing Controlled Substances
[Opioid Safety Tips™]
By: Nathaniel Katz, MD, MS, et al. From: PainBalance.org, 2007.
See details...>
Safe Oral Equianalgesic Opioid Dosing for Patients With Moderate-to-Severe Pain
By: Samuel M. Galvagno, Jr, DO, et al. Resident & Staff Physician; 2007(April);53(4). See details...>
Opioid Safety in Patients With Renal or Hepatic Dysfunction
From: Pain Treatment Topics - Sarah J. Johnson, PharmD, Updated November 2007. See details...>
Opioid Analgesics for Chronic Pain
By: Mary Lou Bossio, NP; from Advance for Physician Assistants; 2007.
See details...>
Managing Opioid-Induced Constipation
From: Pain Treatment Topics - Clyde R. Goodheart, MD, MBA, MS; Stewart B. Leavitt, MA, PhD, August 2006.
Also: Constipation... from Consumer Reports Best-Buy-Drugs, December 2008. See details of both articles...>
Overview of Oral Modified-Release Opioid Products for the Management of Chronic Pain
By: Calene M. Amabile, PharmD, BCPS, and Bill J. Bowman, BSPharm, PhD. Medscape, Ann Pharmacother; 2006;40(7). See details...>
Opioid Tapering: Safely Discontinuing Opioid Analgesics
From: Pain Treatment Topics - Lee A. Kral, PharmD, BCPS, March 2006. See details...>
Opioids for Chronic Nonterminal Pain
By: Jane C. Ballantyne, MD, FRCA; from Medscape; South Med J, 99(11); 2006. Also:
Use of Opioid Analgesics for the Treatment of Chronic Noncancer Pain;
from Canadian Pain Society, 2003.
See details...>
VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain
From: Department of Veterans Affairs, Department of Defense; 2003. Also available...
-- Opioid Assessment & Treatment Pocket Guide
-- Opioid Medications [Dosing] Pocket Guide
See details...>
Opioid/Medication Safety Information for Your Patients
-- How to Evaluate Health Information on the Internet
-- Proper Disposal of Prescription Drugs
-- Facts About Opioids, Methadone, Oxycodone, and Rx Drug Abuse
-- Buying Prescription Medicine Online: A Consumer Safety Guide
See details...>
 See Opioid Therapy & Safety Guidelines <Click Here>
 Also see the following in the Current Comments section...
- The OIH Paradox: Can Opioids Make Pain Worse? See Details…>
- Using Objective Signs of Severe Pain to Guide Opioid Prescribing. See Details…>
- Opioid-Induced Sexual Dysfunction: Causes, Diagnosis, & Treatment. See Details…>
- Should Opioid Abusers Be Discharged From Opioid-Analgesic Therapy? See Details…>
- Maximizing Safety with Methadone & Other Opioids.
See Details…>
- Overcoming Opiophobia & Doing Opioids Right. See Details…>
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 METHADONE Rx & Safety
The following evidence-based research reports focus on factors involved in safer prescribing of effective methadone analgesia.
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Methadone-Drug Interactions to Watch For
PCSS Guidance – Methadone and Drug Interactions
From: Physician Clinical Support System for Methadone (PCSS-M); Elinore F. McCance-Katz, MD, PhD; updated July 2010.
Methadone-Drug* Interactions
(*Medications, illicit drugs, & other substances)
From: Pain Treatment Topics - Stewart B. Leavitt, PhD, 2006.
See details…>
Physician Clinical Support System – Methadone (PCSS-M)
From: SAMHSA/CSAT and ASAM; 2009. See details...>
Follow Directions: How to Use Methadone Safely [Public Outreach Campaign]
From: SAMHSA and FDA; 2009. See details...>
Oral Methadone Dosing for Chronic Pain:
A Practitioner’s Guide
By: James D. Toombs, MD; from Pain Treatment Topics, Updated March 2008. See details...>
Methadone Safety Handout for Patients
(in English and Spanish)
By: Stewart B. Leavitt, MA, PhD; from Pain Treatment Topics, Updated March 2008. See details...>
Keeping Patients Safe from Iatrogenic Methadone Overdoses
From: Institute for Safe Medication Practices (ISMP). February 14, 2008.
See details...>
FDA/DEA Public Health Advisories – Methadone Hydrochloride
From: US Food & Drug Administration and the Drug Enforcement Administration; various dates. See details...>
Revised Methadone Prescribing Information (PI) – October 2006
See details...>
Methadone-Associated Mortality – U.S. Government Reports
From: CSAT (Center for Substance Abuse Treatment), SAMHSA (Substance Abuse and Mental Health Services Administration), 2004
- A National Assessment of Methadone-Associated Mortality:
Background Briefing Report
- Methadone-Associated Mortality: Report of a National Assessment
See details…>
Methadone Cardiac Concerns
From: Addiction Treatment Forum - Stewart B. Leavitt, MA, PhD; Mori J. Krantz, MD, FACC. October 2003. See details…>
"Zero Unintentional Deaths" — Methadone Safety
A special educational website under the direction of Lynn R. Webster, MD. See details...>
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 OXYCODONE Rx & Safety
Oxycodone, alone and in combination with other analgesics, has been used for more than 80 years in the treatment of a variety of acute and chronic pain conditions. Compared with morphine, oxycodone has higher oral bioavailability and is considered twice as potent.
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Commonsense Oxycodone Prescribing & Safety
From: Pain Treatment Topics - Lee A. Kral, PharmD, BCPS, June 2007. See details...>
Patient Instructions Handout: Safely Taking Oxycodone
From: Pain Treatment Topics - Lee A. Kral, PharmD, BCPS and Stewart B. Leavitt, MA, PhD; in English and Spanish, June 2007.
See details...>
Oxycodone: Pharmacological Profile and Clinical Data in Chronic Pain Management
By: F. Coluzzi and C. Mattia, in Minerva Anesthesiologica, 71(7-8), 2005.
See details...>
Oxycodone: Prescribing Information / Package Inserts (PIs)
See details...>
Criteria for Use of Controlled-release Oxycodone
By: Francine Goodman, PharmD, BCPS; William N. Jones, BSc, MSc; and Peter Glassman, MBBS, MSc.Washington, DC: Veterans Health Administration, Department of Veterans Affairs. Revised July 2003.
See details...>
Safety and Efficacy of Controlled-Release Oxycodone: A Systematic Literature Review
By: D. Gary Rischitelli, MD, JD, MPH, and Sean H. Karbowicz, PharmD.
Pharmacotherapy. 2002;22(7):898-904. From Medscape Today.
See details...>
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 Opioid Risk Management
Besides the potential for opioid analgesia adverse effects, which often can be controlled by safe prescribing practices, the risks of greatest concern have been opioid diversion, misuse, abuse, and addiction. Documents in this section offer guidance for better opioid risk management, including: patient risk assessment, risk minimization, and compliance monitoring.
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SECTION: Managing Opioid Emergencies
Managing An Opioid Overdose Crisis
What to know. How to prevent overdose. What to do if it happens.
By: Stewart B. Leavitt, MA, PhD; Addiction Treatment Forum, 2007(Summer). See details...>
Emergency Opioid Tapering During A Disaster
What to do when medication access is interrupted by disaster.
From: National Pain Foundation; undated. See details...>
Take-Home Naloxone (Website)
From: A consortium in the UK; updated continuously. See details...>
Naloxone – Drug Information (Labeling Info)
From: Merck Manual / Lexi-Comp. August 2008. See details...>
Using Naloxone – Fast Facts (Palliative Care)
By: von Gunten CF, Ferris F, and Weissman DE. Fast Fact and Concept #39: Using Naloxone, 2nd Ed. 2005(Jul). End-of-Life Palliative Education Resource Center. See details...>
Naloxone for the Reversal of Opioid Adverse Effects
By: Marcia L. Buck, PharmD in Pediatr Pharm. 2002;8(8). Reproduced on Medscape, 2002. See details...>
Intranasal Naloxone for Acute Opiate Overdose
From: Host source unspecified, undated. See details...>
SECTION: Clinical Tools for Assessing Opioid Risks
Clinical Tools for Assessing Opioid Risks
> From PainEDU.org: SOAPP, COMM
> From EmergingSolutionsInPain.com: ORT, DAST, DIRE,
CAGE-AID, SISAP, 5-Point Rx Opiate Abuse Checklist, POSIT
> From Health.Utah.gov: Checklist for Adverse Effects, Function,
and Opioid Dependence
See details for downloading tools….>
Monitoring Opioid Adherence in Chronic Pain Patients:
Tools, Techniques, and Utility
By: Laxmaiah Manchikanti, MD, et al. Pain Physician. 2008(March);11: S155-S180. See details…>
SECTION: Urine Drug Screening/Testing
A Clinical Guide to Urine Drug Testing:
Augmenting Pain Management and Enhancing Patient Care
By: Catherine A.Hammett-Stabler, PhD, DABCC, FACB and Lynn R.Webster,MD, FACPM, FASAM. From: University of Medicine & Dentistry of New Jersey, Center for Continuing & Outreach Education. 2008. See details…>
Urine Drug Screening: Practical Guide for Clinicians
By: Karen E. Moeller, PharmD, BCPP, et al. Mayo Clinic Proceedings. 2008;83(1):66-76. See details...>
Urine Drug Testing in Clinical Practice:
Dispelling the Myths & Designing Strategies
By: Douglas L. Gourlay, MD, FRCPC, FASAM; Howard A. Heit, MD, FACP, FASAM; Yale H. Caplan, PhD, D-ABFT. From: California Academy of Family Physicians. 2006. A 2-page Quick Reference Guide also is available. See details...>
Commonsense Opioid-Risk Management in Chronic Noncancer Pain: A Clinician’s Perspective
By: James D. Toombs, MD; from Pain Treatment Topics, August 2007.
See details…>
Avoiding Opioid Abuse While Managing Pain:
A Guide for Practitioners (Book)
By: Lynn R. Webster, MD, FACPM, FASAM, and Beth Dove; June 2007.
See review and ordering info...>
Patient Level Opioid Risk Management
By: Nathaniel P. Katz, MD, MS; from PainEDU.com, Inflexxion, Inc., 2007. See details...>
Assessing Obstructive Sleep Apnea Potential, Which May Affect Opioid Risk (Snore Score)
From: American Sleep Apnea Association. 2007. See details...>
Opioids for Pain: Risk Management
By: Steven Richeimer, MD; from California Society of Anesthesiologists; 2006. See details...>
Rapid-Onset Opioids: Recognizing and Preventing Abuse, Addiction, and Diversion
By: Lara K. Dhingra, PhD, and Steven D. Passik, PhD; from Medscape; 2006. See details...>
Universal Precautions in Pain Medicine:
The Treatment of Chronic Pain With or Without the Disease of Addiction
By: Douglas L. Gourlay, MD and Howard A. Heit, MD, in Medscape Neurology & Neurosurgery, 7(1), 2005. See details...>
Treating Pain and Preventing Abuse and Diversion
By: Brian Goldman, MD, MCFP, FACEP, from LearnSomething.com, 2005. See details...>
Opioid Risk Management - THCI Conference Presentations
From: Tufts Health Care Institute, 2005. See details...>
Rights and Responsibilities of Healthcare Professionals in the Use of Opioids for the Treatment of Pain
Consensus from: The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine; 2004. See details...>
Definitions Related to the Use of Opioids for Pain Treatment (Clarifications of "Addiction")
Consensus from: The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. 2001. See details...>
Also See: "Addiction & Pain Treatment " Section
Go to section below...>
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 Opioid Rx Regulatory & Legal Issues
This section focuses on guidance and mandates coming from government agencies -- federal, state, or local -- or medical boards regarding the prescribing, dispensing, and administration of opioid medications.
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DEA - Announcements
From: US Department of Justice, Drug Enforcement Administration. See details...>
DEA Office of Diversion Control - Bulletins
> Don’t Be Scammed By A Drug Abuser
> A Pharmacist’s Guide to Prescription Fraud See details...>
Increasing Patient Access to Pain Meds Around the World:
A Framework to Improve National Policies that Govern Drug Distribution
From: Pain & Policy Studies Group. University of Wisconsin Paul P. Carbone Comprehensive Cancer Center; Madison, Wisconsin; 2008.
See details...>
Achieving Balance in Federal and State Pain Policy
From: Pain & Policy Studies Group; University of Wisconsin Paul P. Carbone Comprehensive Cancer Center; Madison, Wisconsin; Updated July 2008. Also available: Progress Report Card. See details...>
Practitioner’s Manual — An Informational Outline of the Controlled Substances Act
From: US Department of Justice, Drug Enforcement Administration, Office of Diversion Control, August 2006.
Also available: Reference Lists of Controlled Substances.
See details...>
Model Policy for the Use of Controlled Substances
From: Federation of State Medical Boards of the United States, Inc.; May 2004. See details...>
Prescription Monitoring Programs (PMPs)
From: Pain & Policies Study Group, University of Wisconsin and National Association for Model State Drug Laws. See details...>
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 Addiction & Pain Treatment
The interface of addiction and pain treatment – particularly with opioid analgesics – is a common and vexing problem in clinical practice. This is complicated further by misunderstandings of distinctions between substance misuse, abuse, dependence, addiction, and pseudoaddiction.
This section of Pain Treatment Topics focuses on the clarification, identification, prevention, and treatment of addictive disorders within the context of pain and, conversely, on pain management with opioids in persons having a history of addiction.
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EUROPAD Journal on Addiction
 Full editions available for free download as PDF documents.
See journal listings...>
A Pain Treatment Topics affiliate organization.
SAMHSA Substance Abuse Treatment Facility Locator
From: U.S. Substance Abuse & Mental Health Services Administration (SAMHSA). Regularly updated. See details...>
NIDAMED Resources for Medical and Health Professionals [Drug Screening]
From: NIDA (National Institute on Drug Abuse); 2009. See details...>
Principles of Drug Addiction Treatment: A Research Based Guide (2nd Edition)
From: NIDA (National Institute on Drug Abuse); Revised April 2009.
See details...>
Best Biomarkers to Detect Underreported Alcohol Use
By: David R. Spiegel, MD; Neetu Dhadwal, MD; Frances Gill, MD. From Current Psychiatry; 2008 (September). See details...>
Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders
By: Seddon R. Savage, MD, Kenneth L. Kirsh, PhD, and Steven D. Passik, PhD. From Addiction Science & Clinical Practice (a NIDA publication). 2008(June). See details...>
The Management of Breakthrough Pain With Rapid-Onset Opioids: Abuse, Addiction, and Diversion
By: Steven D. Passik, PhD and Kenneth L. Kirsh, PhD. From Medscape Neurology & Neurosurgery. 2008. See details...>
The New Science of Addiction
From: University of Utah, Genetics Science Learning Center. Updated 2008. See details...>
Safe Treatment of Pain in the Patient With a Substance Use Disorder
By: Penelope P. Ziegler, MD, FASAM; Psychiatric Times (CMP Medica), 24(1), 2007. See details...>
Pain Management Without Psychological Dependence: A Guide for Healthcare Providers
From: Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse in Brief Fact Sheet. 2006(Summer);4(1).
See details...>
Pain in Opioid-Addicted Patients Entering Addiction Treatment
By: Stewart B. Leavitt, MA, PhD, revised July 2006. Adapted from Addiction Treatment Forum, 2004 (Winter);13(1). See details...>
Treatment of Acute Pain in Patients Receiving Buprenorphine/Naloxone for Addiction
By: David Fiellin, MD; from the Physician Clinical Support System (PCSS), 2005. See details...>
ASPMN Position Statement: Pain Management in Patients with Addictive Disease
From: American Society for Pain Management Nursing (ASPMN), September 2002. See details...>
Definitions Related to the Use of Opioids for the Treatment of Pain (including clarifications of addiction)
A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. 2001. Go to PDF...>
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Pain Treatment Topics and its associates do not endorse any medications, products, services, or treatments described, mentioned, or discussed in any of the sources referenced. Nor are any representations made concerning efficacy, appropriateness, or suitability of any such medications, products, services, or treatments.
In view of the possibility of human error or advances in medical knowledge, Pain Treatment Topics and its associates do not warrant the information contained in the above Opioid Rx contents is in every respect accurate or complete, and they are not responsible nor liable for any errors or omissions made by the original sources or for results obtained from the use of this information. Also see, Site Policies. |
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