New Department of Veterans Affairs and Department of Defense Guidelines on Pain Management With Opioids: Comment and Concern
Authors: A. Thomas McLellan
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions4 July 2017New Department of Veterans Affairs and Department of Defense Guidelines on Pain Management With Opioids: Comment and ConcernA. Thomas McLellan, PhDA. Thomas McLellan, PhDFrom Treatment Research Institute, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0814 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Department of Veterans Affairs (VA) and the Department of Defense (DoD) have revised their 2010 guidelines on prescribing opioids for the management of chronic noncancer pain (CNCP) (1). This is a very welcome and timely update for several reasons. First, CNCP is among the most prevalent conditions in all of medicine, and this has contributed to making opioids the most widely prescribed class of medications (2). This growth in opioid prescribing has been associated with growth in serious public health problems, including diversion, overdose deaths, and addiction (3, 4).The scale of opioid use and associated side effects is ...References1. U.S. Department of Veterans Affairs/U.S. Department of Defense. VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain (2017). Accessed at www.healthquality.va.gov/guidelines/Pain/cot/ on 15 February 2017. Google Scholar2. Stone K. The most prescribed medications by drug class. The Balance. 13 October 2016. Accessed at www.thebalance.com/the-most-prescribed-medications-by-drug-class-2663215 on 15 February 2017. Google Scholar3. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:276-86. [PMID: 25581257]. doi:10.7326/M14-2559 LinkGoogle Scholar4. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378-82. [PMID: 26720857] doi:10.15585/mmwr.mm6450a3 CrossrefMedlineGoogle Scholar5. Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville: Substance Abuse and Mental Health Services Administration; 2016. Google Scholar6. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315:1624-45. [PMID: 26977696] doi:10.1001/jama.2016.1464 CrossrefMedlineGoogle Scholar7. Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, DiCapua P, et al. Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain. Ann Intern Med. 2014;160:38-47. [PMID: 24217469]. doi:10.7326/0003-4819-160-1-201401070-00732 LinkGoogle Scholar8. Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, Boswell MV, et al; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I—evidence assessment. Pain Physician. 2012;15:S1-65. [PMID: 22786448] CrossrefMedlineGoogle Scholar9. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington, DC: HHS; 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Treatment Research Institute, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0814.Corresponding Author: A. Thomas McLellan, PhD, Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall, Philadelphia, PA 19106; e-mail, [email protected]org.Author Contributions: Conception and design: A.T. McLellan.Analysis and interpretation of the data: A.T. McLellan.Drafting of the article: A.T. McLellan.Final approval of the article: A.T. McLellan.This article was published at Annals.org on 30 May 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIndependent Validation in a Large Privately Insured Population of the Risk Index for Serious Prescription Opioid–Induced Respiratory Depression or OverdosePain-Induced Alcohol Urge and Intention to Drink: the Role of Dispositional MindfulnessResistance to Limiting Opioids for Chronic Pain in the United States—Even as the Death Toll Rises 4 July 2017Volume 167, Issue 1Page: 50-51KeywordsDisclosureDrugsHealth surveysOpioid addictionOpioidsPain managementPrevention, policy, and public healthSurgeonsTherapeutic drug monitoringTreatment guidelines ePublished: 30 May 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...