• Taghogho Agarin, Andrea M Trescot, Aniefiok Agarin, Doreena Lesanics, and Claricio Decastro.
• UCSD Center for Pain Medicine, La Jolla CA; Algone Pain Center, Wasila, Alaska; Dept. of Psychiatry, University of California, San Diego; Dept. Of Psychiatry, Harlem Hospital, Columbia University, NY.
• Pain Physician. 2015 May 1;18(3):E307-22.

BackgroundAvailable data have shown steady increases of drug overdose deaths between 1992 and 2011. We review evidenced-based recommendations provided by a few prominent North American pain societies and suggest ways on how health providers might help reduce opioid analgesic deaths by implementing these practices.ObjectiveTo identify health care providers' roles in reducing opioid analgesic deaths.Study DesignA comprehensive review of current literature.MethodsThe review included relevant literature identified through searches of MEDLINE, Cochran reviews, and Google Scholar, PubMed and EMBASE from January 1998 to January 2014. The level of evidence was classified as I (good), II (fair), and III (limited) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).ResultsSeveral practices such as too high doses overall, giving too high doses to opioid naive patients, too fast opioid titration, insufficient use and knowledge of urine drug testing, not updating knowledge of drug metabolism/interactions, and inadequate patient monitoring are associated with higher risks of opioid analgesic deaths. Suboptimal risk stratification of patients, rotation practices, and use of opioids analgesics in chronic noncancer pain are also associated factors.LimitationsThere were a paucity of good evidence studies which show recommendations reduce death.ConclusionProviders should be aware of all associated factors with opiate analgesic deaths and apply the available evidence in reducing opioid analgesic deaths.

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