Clinical pharmacology and therapeutics
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Clin. Pharmacol. Ther. · Jun 2018
Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education.
In the US, deaths from prescription opioids have quadrupled since 1999, prompting authorities to declare an "opioid abuse" crisis. Rising overdose deaths were attributed to trends in the overprescription of opioids, specifically the strength and duration of the initial prescription. ⋯ A review of relevant programs for practicing providers, medical residents, and medical students reveals a focus on educational interventions that we describe, borrowing from sociologist John McKinlay's metaphor for public health interventions, as "downstream." These downstream interventions concentrate on regulating and educating practicing HCPs rather than transforming the training environment for medical students and residents. We draw on theories of behavior change to call for the development of complementary "upstream" educational programs for future practitioners that focus on structural and psychosocial factors and may contribute to more sustainable behavior change outcomes.
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Public health policy responses to the opioid epidemic require addressing both opioid supply and opioid demand. The growth in prescriptions of opioid analgesics, for example, is associated with escalating opioid overdose fatalities.1 Enhanced access to opioid agonist treatment, conversely, is required to curb demands driven by opioid use disorders. Oregon's multidimensional approaches toward opioid misuse and abuse achieved 20% reductions in opioid prescribing and a 30% reduction in the opioid overdose fatality rate.
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Guidelines for opioid prescribing in noncancer pain have proliferated since the opioid crisis in the United States became widely recognized. The recently published Centers for Disease Control (CDC) guidelines for opioid prescribing have been controversial. Many of these concerns arise from underestimation of the scale of the opioid crisis, as well as misunderstanding what the guidelines actually say. Strict guidelines should be welcomed as a constructive approach to managing a thorny public health issue.
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Clin. Pharmacol. Ther. · Jun 2018
The CDC Opioid Guideline: Proponent Interpretation Has Led to Misinformation.
Pain management epitomizes the value of a multidisciplinary approach to caring for patients, yet regrettably, the term pain management has too often become synonymous with prescribing opioids only. Optimal chronic pain management requires a skillset most conducive to a multidisciplinary team approach and should be performed in a scientifically and clinically sound manner. It is with these facts in mind that we offer our view of the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain.
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Clin. Pharmacol. Ther. · Jun 2018
CommentCritiquing the CDC Opioid Guideline: Some Light From the Heat.
Released in 2016, the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain has been met with both praise and criticism. In this issue of the Journal, two commentaries address the guideline's strengths and limitations. While the authors differ in their assessment of the guideline, they share a common objective: safer opioid prescribing. Followed carefully, the CDC guideline will facilitate this, but followed carelessly it has the potential to cause harm.