Opioid Analgesic Guidelines Strike Delicate Balance

Clear answers to questions about the benefits and risks involved in using opioid analgesics such as morphine and oxycodone for the treatment of severe pain are now available to health care professionals and law enforcement officers.

A new document containing this potentially valuable information comes from a collaboration between the U.S. Department of Justice Drug Enforcement Administration (DEA), Last Acts Partnership, and the Pain and Policy Studies Group at the University of Wisconsin–Madison Medical School.

Last Acts Partnership is a nonprofit organization dedicated to improving end-of-life care.

“Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel” addresses issues such as how opioid analgesics are used to treat chronic pain and how clinicians can assess patients for signs of abuse and addiction to these medications.

An introduction to the document states, “Responses derive from the fundamental view that practitioners must try to relieve pain, but also must obey laws and regulations and avoid contributing to diversion [of these medications], while law enforcement personnel and regulators must address the sources of diversion, but do so in a manner that never interferes in clinical pain management.”

The publication is divided into several sections, including one on the medical use of opioid analgesics, which addresses potential confusion between physical dependence, tolerance, and addiction to a drug.

“This confusion can lead to the withholding of opioid medication because of a mistaken belief that a patient is addicted when he or she is merely physically dependent,” the document states, which can lead to“ inappropriate targeting of practitioners and patients for investigation and prosecution and to excessive and unfounded fear of opioid use among patients and the public.”

Under the section titled “Risks in the Medical Use of Opioid Analgesics,” clinicians are educated about problem behaviors that may indicate that a patient is abusing or addicted to the medication, such as the use of multiple physicians and/or pharmacies, multiple claims that prescriptions have been lost or stolen, and injection or snorting of the medication, for example. However, such behaviors could also be associated with the “desperate search for pain relief,” and with other psychosocial disturbances related to untreated pain, the authors pointed out.

In an August press release from the Pain Policy and Studies Group, Russell Portenoy, M.D., chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York and the lead pain expert on the project, said, “We have two serious societal problems—the undertreatment of pain, and drug abuse and diversion that are intertwined through prescription pain medications. We address both problems in this document and hope it will bring some clarity to the issue.”

The DEA, Last Acts Partnership, and the Pain and Policy Studies Group united in 2001 to develop the consensus statement, “Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act.”

“Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel” is posted online at<www.medsch.wisc.edu/painpolicy/>.▪