Tackling the Difficult Problem of Prescription Opioid Misuse
Authors: Howard A. Heit
Journal: Annals of Internal Medicine (2010)

Editorials1 June 2010Tackling the Difficult Problem of Prescription Opioid MisuseHoward A. Heit, MD and Douglas L. Gourlay, MD, MScHoward A. Heit, MDFrom Georgetown School of Medicine, Fairfax, VA 22031, and Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada.Search for more papers by this author and Douglas L. Gourlay, MD, MScFrom Georgetown School of Medicine, Fairfax, VA 22031, and Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-11-201006010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Stories about the tragic consequences of prescription drug misuse increasingly populate the media. In 2007, the Substance Abuse and Mental Health Services Administration revealed that in the previous year, illicit use of prescription opioids exceeded that of marijuana among persons 12 years or older (1). Clearly, times are changing, and abuse of prescription drugs is something clinicians must actively address. In this issue, Starrels and colleagues (2) report a review of the evidence about the effectiveness of 2 common clinical tools to reduce opioid misuse in patients with chronic pain: opioid treatment agreements and urine drug testing. We commend the ...References1. Substance Abuse and Mental Health Services Administration. Results from the 2006 National Survey on Drug Use and Health Report. Rockville, MD: Office of Applied Studies; 2007. NSDUH Series H-32, DHHS publication no. SMA 07-4293. Google Scholar2. Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010;152:712-20. LinkGoogle Scholar3. Heit HA. Addiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients. J Pain Palliat Care Pharmacother. 2003;17:15-29. [PMID: 14640337] MedlineGoogle Scholar4. Heit HA, Gourlay DL. DSM-V and the definitions: time to get it right. Pain Med. 2009;10:784-6. [PMID: 19558593] CrossrefMedlineGoogle Scholar5. Gourlay DL, Heit HA. Pain and addiction: managing risk through comprehensive care. J Addict Dis. 2008;27:23-30. [PMID: 18956526] CrossrefMedlineGoogle Scholar6. Jacobellis v. Ohio. 378 US184 (1964). Google Scholar7. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010;:CD006605. [PMID: 20091598] MedlineGoogle Scholar8. Model Policy for the Use of Controlled Substances for the Treatment of Pain. Policy Statement: Federation of State Medical Boards of the United States; 2004. Accessed at www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf on 22 April 2010. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Georgetown School of Medicine, Fairfax, VA 22031, and Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0858.Corresponding Author: Howard A. Heit, MD, Georgetown School of Medicine, Department of Medicine, 8316 Arlington Boulevard, Suite 232, Fairfax, VA 22031; e-mail, [email protected]com.Current Author Addresses: Dr. Heit: Georgetown School of Medicine, Department of Medicine, 8316 Arlington Boulevard, Suite 232, Fairfax, VA 22031.Dr. Gourlay: Wasser Pain Management Centre, Department of Anesthesiology and Psychiatry, Room 1160, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients With Chronic Pain Joanna L. Starrels , William C. Becker , Daniel P. Alford , Alok Kapoor , Arthur Robinson Williams , and Barbara J. Turner Urine Drug Testing Is Still an Invaluable Resource for Primary Care Gary M. Reisfield , Noni A. Graham , and Mark S. Gold Metrics Cited ByPrescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristicsTreatment Agreements, Informed Consent, and the Role of State Medical Boards in Opioid PrescribingRecommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic PainAcute Pain Management in Opioid-Tolerant Patients: A Growing ChallengeUrine Drug Testing Is Still an Invaluable Resource for Primary CareGary M. Reisfield, MD, Noni A. Graham, MPH, and Mark S. Gold, MD 1 June 2010Volume 152, Issue 11Page: 747-748KeywordsBehaviorDrug addictionDrugsOpioid addictionOpioidsRisk managementSafetySubstance abuseTreatment guidelinesUrine ePublished: 1 June 2010 Issue Published: 1 June 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...