Physicians misguided about misuse of opioids?

A majority of physicians think that only a small number of their patients misuse or abuse opioid analgesics obtained from a prescription and just more than half think that most cases of opioid abuse do not involve tampering with the medication’s delivery system, according to a national survey sponsored by the American Pain Foundation (APF). However, published data show that 80% of prescription medication abusers seeking treatment chew, snort, or use intravenous administration of oral medicines to attain an immediate high. This contrast between the perception and reality of opioid misuse and abuse suggests that both professional and public education and open dialogue between physicians and patients are needed to promote responsible pain management.

In 2008, 35 million Americans 12 years and older reported nonmedical use of prescription opioids during their lifetime, according to Substance Abuse and Mental Health Services Administration (SAMHSA) statistics. SAMHSA’s National Survey on Drug Use and Health showed that from 2008 to 2009, nonmedical use of prescription drugs increased from 2.5% to 2.8% of the population and the overall rate of current illicit drug use increased from 8% to 8.7% of persons 12 years and older.

Alleviating pain is a medical imperative, the APF noted, but it must be balanced with measures to address the misuse and abuse of prescription pain medication. Additional survey findings include the following:

•Physicians are acutely aware of the dangers of opioid misuse and abuse.

•The majority of surveyed physicians (87%) agree that most recreational users of opioids obtain them from a legitimate prescription.

•Fewer than half (41%) of the surveyed physicians do not take steps to prevent the misuse and abuse of opioids in their own homes.

For physicians to overcome common misunderstandings about these medications, the APF recommends that they initiate an open dialogue about responsible pain management before and during treatment. Discussions might include proper dosing, storage and disposal of prescription medications to protect patients and their families from the risks associated with them, and consideration of new treatment options. Several companies are developing pain medications designed to deter or prevent common forms of medication abuse and tampering, the APF noted, but their potential to address misuse and abuse has not yet been demonstrated.

The Physician Perspective Toward Prescription Opioid Abuse and Misuse Survey was a national online poll of 500 board-certified US physicians (in primary care, neurology, and orthopedic surgery) who treat patients whose conditions require prescription opioid analgesics. The goal was to gain a better understanding of prescriber awareness of opioid misuse and abuse, including prevalence, patient discussions, attitude, and sources of misused opioids.

The APF also recently launched PainSAFE (Pain Safety & Access For Everyone), an initiative designed to provide pain education to health care professionals and persons affected by pain about appropriate and safe use of pain management therapies. The goal is to help reduce risk and improve access to high-quality pain care.

PainSAFE, a Web-based program, provides patients with up-to-date information, programming, and practical resources and tools about pain treatment options and their use. Health care professionals are offered a central hub of evidence-based information and practice-based tools to focus on safety and reduce the risks associated with various pain treatments.

PainSAFE is a multiyear project that will address all treatment options for patients with pain. The first modules focus on pain treatment with opioid analgesics and implantable pain therapies; modules that address over-the-counter pain treatments (acetaminophen and NSAIDs) and complementary and alternative medicine therapies are in development. PainSAFE also is designed to help improve understanding of the risks and benefits of individual treatment programs.

For more information about the misuse and abuse of opioid analgesics, visit the APF Web site at http://www.painfoundation.org. Or, contact the organization at American Pain Foundation, 201 N. Charles Street, Suite 710, Baltimore, MD 21201-4111; telephone: (410) 783-7292; fax: (410) 385-1832. For more information about the PainSAFE program and materials, visit  http://www.painsafe.org.

For a discussion of the use and misuse of opioids for chronic musculoskeletal pain, such as rheumatoid arthritis, osteoarthritis, and low back pain, go to “Podcasts” in the “Rheumatoid Arthritis Resource Center” on www.musculoskeletalnetwork.com to hear “Opioids for the treatment of chronic musculoskeletal pain: Myths and misunderstandings” by addiction medicine and pain management specialist Jennifer P. Schneider, MD, PhD.