More than 68,000 Americans died of opioid-involved overdose in 2020—a 37.6 percent increase over 2019, and the largest yearly increase in opioid-involved overdose deaths in two decades.1,* A total of 16,416 (23.9 percent) of those deaths involved prescription opioids.1 Approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them,2 and between 8 and 12 percent of patients prescribed opioids for chronic pain will develop an opioid use disorder (OUD).2 It’s no surprise, then, that overdose death involving opioids is referred to as “a public health emergency” and an epidemic.3,4Learn More »
In 2016, the CDC released a clinical practice guideline for primary care physicians prescribing opioids for chronic pain,1 which was adopted by various entities, including Medicaid agencies and insurers.2 However, according to the CDC and others, the guideline has been misinterpreted and misapplied. An example of a misapplication concern involves the management of patients with chronic pain, which are not intended to follow the same guidelines as those patients being initiated on opioids.
In the years since the 2016 Guideline came out, the CDC and others have published reports, commentaries, and guidelines intended to reduce some of the confusion surrounding pain management in patients for whom opioid therapy is appropriate. In November 2022, the CDC also released their new Clinical Practice Guideline for Prescribing Opioids for Pain, which updates and replaces the 2016 Guideline.Learn More »
According to the CDC, chronic pain is a risk factor for suicidality.1,2,3 Studies indicate several additional factors as potential predicators of increased suicide risk in chronic pain patients, including depression, anger, unemployment/disability, harmful health habits, challenging personal and family history, sleep problems, poor perceived mental health, and multiple chronic pain conditions. Newly identified psychosocial factors, including pain catastrophizing, hopelessness, and perceived burdensomeness also appear to be associated with suicidality.2 On a positive note, many suicide risk factors can be addressed through an individualized chronic pain management program.2Learn More »
Any patient can develop OUD and patients with OUD are at higher risk for overdose.1 Personal history, length of therapy, and dosage play a role in the development of OUD.2 A physician’s effectiveness in treating the underlying cause of a patient’s pain can be a crucial aspect of the defense in an opioid overdose case.Learn More »
The most conservative addiction and overdose prevention policies and procedures can’t protect a primary care clinician from inheriting a patient who is taking high doses of opioids for chronic pain. In many cases, because of the patient’s limited resources or the limited number of specialists in the community, primary care clinicians are expected to satisfy the patient’s needs for specialty care, including pain management, mental health, and physical therapy. Although there is no perfect solution for clinicians faced with these challenging patients, the following recommendations can decrease the risk of overdose and increase the chance that patients can be transitioned to safer pain management:*Learn More »