Experts Urge Better Training, Education to Increase Opioid Safety

More comprehensive education is needed for opioid prescribers, two experts write this week in the Journal of the American Medical Association (JAMA). MedPageToday reports that they also call for adoption of guidelines on opioid prescribing from the American Academy of Pain Medicine.

Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse, and Thomas A. McLellan, Ph.D., Professor, Dept. of Psychiatry, and Director, Penn Center for Substance Abuse Solutions, call on patients to become more aware and responsible for how they use, store and dispose of opioids. Their commentary accompanies a study in this week’s JAMA that finds that higher doses of opioid medication is associated with an increased risk of accidental overdose.

Dr. Volkow was also lead author on a research letter in the same issue of JAMA about the characteristics of opioid prescriptions. In 2009, she wrote, there were 79.5 million prescriptions for opioids, mostly for hydrocodone and oxycodone products.

She notes that 46 percent of prescriptions were for patients ages 40 to 59, while 11.7 percent were for patients 10 to 29. She says this is a high percentage and asks whether this is a potential problem for this age group, which is the most likely to abuse drugs and develop an addiction. She also asks whether the percentage of opioid prescriptions that were filled by patients who had recently received another opioids prescription (56 percent) hints at the need to “improve information infrastructures that could enhance the safety of prescribed opioids analgesics and minimize diversion.”

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    Stewart B. Leavitt, MA, PhD

    April 8, 2011 at 7:22 PM

    I would be interested to know what makes Volkow and McLellan — two otherwise sensible professionals — believe that the APS/AAPM guidelines on opioid prescribing are of any practical use. By admission of the guidelines developers their recommendations were based on weak evidence, and they wrote a whole second guideline document outlining serious gaps in opioid Rxing knowledge. Let’s not start adopting guidelines just because they are the only ones available — it will end up doing more harm than good. Just my opinion (based on the evidence). — SBL

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    Michael McCarthy

    April 7, 2011 at 3:40 PM

    We have a serious problem with patients who are hospitalized, treated with opiates, given a prescription on release and discharged into the care of a physician with no coaching on how to stop using the drug.
    At our addictions clinic we are seeing many people who have spent years addicted and buying oxycodone illegally as a result and in bad shape.
    A formal hospital release strategy is required to prevent this cycle continuing. We are creating addicts!

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