Care Fragmentation and Prescription Opioids
Authors: Laurence J. Meyer, Carolyn M. Clancy
Journal: Annals of Internal Medicine (2019)

Editorials2 April 2019Care Fragmentation and Prescription OpioidsLaurence J. Meyer, MD, PhD and Carolyn M. Clancy, MDLaurence J. Meyer, MD, PhDU.S. Department of Veterans Affairs, Washington, DC (L.J.M., C.M.C.)Search for more papers by this author and Carolyn M. Clancy, MDU.S. Department of Veterans Affairs, Washington, DC (L.J.M., C.M.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0492 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail According to some estimates, up to 80% of Americans who are now addicted to an opioid were first exposed through a prescription, either their own or that of a friend or family member (1). The dramatic increase in prescription opioid use (especially long-acting formulations) has been associated with 2 interrelated factors: clinicians' well-intended focus on pain as the fifth vital sign and the faulty premise that appropriate use of opioids for treating chronic pain does not lead to addiction. In addition, at least 1 study shows that increased prescriptions are correlated with marketing efforts by drug manufacturers (2).In the ...References1. Bonnie RJ, Ford MA, Phillips JK, eds. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: National Academies Pr; 2017. Google Scholar2. Hadland SE, Rivera-Aguirre A, Marshall BDL, Cerdá M. Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Netw Open. 2019;2:e186007. [PMID: 30657529] doi:10.1001/jamanetworkopen.2018.6007 CrossrefMedlineGoogle Scholar3. Moyo P, Zhao X, Thorpe CT, Thorpe JM, Sileanu FE, Cashy JP, et al. Dual receipt of prescription opioids from the Department of Veterans Affairs and Medicare Part D and prescription opioid overdose death among veterans. A nested case–control study. Ann Intern Med. 2019;170:433-42. doi:10.7326/M18-2574 LinkGoogle Scholar4. Bohnert ASB, Ilgen MA. Understanding links among opioid use, overdose, and suicide. N Engl J Med. 2019;380:71-9. [PMID: 30601750] doi:10.1056/NEJMra1802148 CrossrefMedlineGoogle Scholar5. Fink DS, Schleimer JP, Sarvet A, Grover KK, Delcher C, Castillo-Carniglia A, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168:783-90. [PMID: 29801093]. doi:10.7326/M17-3074 LinkGoogle Scholar6. Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319:872-82. [PMID: 29509867] doi:10.1001/jama.2018.0899 CrossrefMedlineGoogle Scholar7. Hadlandsmyth K, Mosher H, VanderWeg MW, Lund BC. Decline in prescription opioids attributable to decreases in long-term use: a retrospective study in the Veterans Health Administration 2010–2016. J Gen Intern Med. 2018;33:818-24. [PMID: 29380212] doi:10.1007/s11606-017-4283-8 CrossrefMedlineGoogle Scholar8. Toblin RL, Quartana PJ, Riviere LA, Walper KC, Hoge CW. Chronic pain and opioid use in US soldiers after combat deployment. JAMA Intern Med. 2014;174:1400-1. [PMID: 24978399] doi:10.1001/jamainternmed.2014.2726 CrossrefMedlineGoogle Scholar9. National Center for Health Statistics. Health, United States, 2017: With Special Feature on Mortality. Hyattsville, MD: National Center for Health Statistics; 2018. Google Scholar10. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67:1419-27. [PMID: 30605448] doi:10.15585/mmwr.mm67515 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: U.S. Department of Veterans Affairs, Washington, DC (L.J.M., C.M.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0492.Corresponding Author: Carolyn M. Clancy, MD, U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420; e-mail, carolyn.[email protected]gov.Current Author Addresses: Drs. Meyer and Clancy: U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420.This article was published at Annals.org on 12 March 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans Patience Moyo , Xinhua Zhao , Carolyn T. Thorpe , Joshua M. Thorpe , Florentina E. Sileanu , John P. Cashy , Jennifer A. Hale , Maria K. Mor , Thomas R. Radomski , Julie M. Donohue , Leslie R.M. Hausmann , Joseph T. Hanlon , Chester B. Good , Michael J. Fine , and Walid F. Gellad Metrics Cited byPredictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer ClaimsVA-Community Dual Care: Veteran and Clinician Perspectives 2 April 2019Volume 170, Issue 7Page: 497-498KeywordsAnalgesicsDisclosureDrug marketingHealth careHealth education and awarenessHealth systems strengtheningMedicareOpioidsVeteran careVital signs ePublished: 12 March 2019 Issue Published: 2 April 2019 PDF downloadLoading ...