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Primary care management of Long-Term opioid therapy

The United States underwent massive expansion in opioid prescribing from 1990–2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumsta...

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Autores principales: Coffin, Phillip O., Martinez, Rebecca S., Wylie, Brian, Ryder, Bunny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9487960/
https://www.ncbi.nlm.nih.gov/pubmed/36111417
http://dx.doi.org/10.1080/07853890.2022.2121417
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author Coffin, Phillip O.
Martinez, Rebecca S.
Wylie, Brian
Ryder, Bunny
author_facet Coffin, Phillip O.
Martinez, Rebecca S.
Wylie, Brian
Ryder, Bunny
author_sort Coffin, Phillip O.
collection PubMed
description The United States underwent massive expansion in opioid prescribing from 1990–2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumstances. Patients who have been treated with opioids long-term should be managed differently, sometimes even continued on opioids due to physiologic changes wrought by long-term opioid therapy and documented risks of discontinuation. When providing long-term opioid therapy, clinicians should document opioid stewardship measures, including assessments, consents, medication reconciliation, and offering naloxone, along with the rationale to continue opioid therapy. Clinicians should screen regularly for opioid use disorder and arrange for or directly provide treatment. In particular, buprenorphine can be highly useful for co-morbid pain and opioid use disorder. Addressing other substance use disorders, as well as preventive health related to substance use, should be a priority in patients with opioid use disorder. Patient-centered practices, such as shared decision-making and attending to related facets of a patient’s life that influence health outcomes, should be implemented at all points of care. KEY MESSAGES: Although opioids are no longer considered first-line therapy for most chronic pain, management of patients already taking long-term opioid therapy must be individualised. Documentation of opioid stewardship measures can help to organise opioid prescribing and protect clinicians from regulatory scrutiny. Management of resultant opioid use disorder should include provision of medications, most often buprenorphine, and several additional screening and preventive measures.
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spelling pubmed-94879602022-09-21 Primary care management of Long-Term opioid therapy Coffin, Phillip O. Martinez, Rebecca S. Wylie, Brian Ryder, Bunny Ann Med Addiction The United States underwent massive expansion in opioid prescribing from 1990–2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumstances. Patients who have been treated with opioids long-term should be managed differently, sometimes even continued on opioids due to physiologic changes wrought by long-term opioid therapy and documented risks of discontinuation. When providing long-term opioid therapy, clinicians should document opioid stewardship measures, including assessments, consents, medication reconciliation, and offering naloxone, along with the rationale to continue opioid therapy. Clinicians should screen regularly for opioid use disorder and arrange for or directly provide treatment. In particular, buprenorphine can be highly useful for co-morbid pain and opioid use disorder. Addressing other substance use disorders, as well as preventive health related to substance use, should be a priority in patients with opioid use disorder. Patient-centered practices, such as shared decision-making and attending to related facets of a patient’s life that influence health outcomes, should be implemented at all points of care. KEY MESSAGES: Although opioids are no longer considered first-line therapy for most chronic pain, management of patients already taking long-term opioid therapy must be individualised. Documentation of opioid stewardship measures can help to organise opioid prescribing and protect clinicians from regulatory scrutiny. Management of resultant opioid use disorder should include provision of medications, most often buprenorphine, and several additional screening and preventive measures. Taylor & Francis 2022-09-16 /pmc/articles/PMC9487960/ /pubmed/36111417 http://dx.doi.org/10.1080/07853890.2022.2121417 Text en © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Addiction
Coffin, Phillip O.
Martinez, Rebecca S.
Wylie, Brian
Ryder, Bunny
Primary care management of Long-Term opioid therapy
title Primary care management of Long-Term opioid therapy
title_full Primary care management of Long-Term opioid therapy
title_fullStr Primary care management of Long-Term opioid therapy
title_full_unstemmed Primary care management of Long-Term opioid therapy
title_short Primary care management of Long-Term opioid therapy
title_sort primary care management of long-term opioid therapy
topic Addiction
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9487960/
https://www.ncbi.nlm.nih.gov/pubmed/36111417
http://dx.doi.org/10.1080/07853890.2022.2121417
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