Abstract
The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35–54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.
GLOSSARY
- AAN=
- American Academy of Neurology;
- CNCP=
- chronic noncancer pain;
- COAT=
- chronic opioid analgesic therapy;
- FDA=
- Food and Drug Administration;
- MCID=
- minimum clinically important difference;
- MED=
- morphine equivalent dose;
- PDMP=
- Prescription Drug Monitoring Programs;
- RCT=
- randomized controlled trials;
- REMS=
- Risk Evaluation and Mitigation Strategies;
- VA=
- Veterans Affairs
Footnotes
Approved by the Patient Safety Subcommittee on December 27, 2013; by the Practice Committee on January 13, 2014; and by the AAN Board of Directors on March 4, 2014. Following Neurology® peer review and approval, this document was resubmitted to the AAN Board of Directors and approved on June 24, 2014.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of this article.
Supplemental data at Neurology.org
- Received March 12, 2014.
- Accepted in final form June 13, 2014.
- © 2014 American Academy of Neurology
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