Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2018
Ensuring and Restoring Balance on Access to Controlled Substances for Medical and Scientific Purposes: Joint Statement from Palliative Care Organizations.
The central principle of "balance" represents the dual obligation of governments to establish a system of control that ensures the adequate availability of controlled substances for medical and scientific purposes while simultaneously preventing their nonmedical use, diversion, and trafficking, two primary goals of the international control system. On the one hand, although strong opioids, including morphine, are absolutely necessary for the relief of severe pain, legitimate access to opioids for pain treatment and palliative care is lacking in the majority of the world's countries. ⋯ Although nonmedical use of controlled substances poses a risk to society, the system of control is not intended to be a barrier to their availability for medical and scientific purposes, nor to interfere in their legitimate medical use for patient care. As representatives of palliative care organizations, we urge heads of state to act and to take measures to ensure and restore balanced systems in their countries and call on public health leaders and regulators to work together.
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J Pain Palliat Care Pharmacother · Jun 2018
Things to Consider When Completing an Advance Directive.
Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In response to a question about advance directives for a patient experiencing chronic pain, the authors discuss the importance of having legal documents in place.
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J Pain Palliat Care Pharmacother · Jun 2018
ReviewPublic Policy: An Analgesia for Opioid Diversion.
Although opioids are a commonly prescribed form of analgesics among the armamentarium for their efficacy and safety when used responsibly, societal problems of drug diversion are highly prevalent. This review seeks to examine the importance of opioids and the extent of diversion and its impact, drawbacks, and controversies in law, public policies, and strategies. In particular, the law has skewed its focus toward the regulation of opioid suppliers (as compared to consumers), giving rise to a chilling effect where physicians are hesitant to prescribe opioids to patients with legitimate needs. ⋯ This article recommends the intelligent use of public policy to alleviate the opioid diversion problem while acknowledging the importance of appropriate pain management. Concurrently, this article recommends providing continuous education and support for physicians, dispensers, and the like and adoption of soft law approaches by legislators and enforcement bodies to prevent relentless clamping down on opioid abusers. In conclusion, appropriate policies and guidelines are necessary to support the entire health care body in executing a coordinated approach and exercising vigilance to better manage the opioid diversion problem.
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J Pain Palliat Care Pharmacother · Jun 2018
Natural Language Processing-Identified Problem Opioid Use and Its Associated Health Care Costs.
Use of prescription opioids and problems of abuse and addiction have increased over the past decade. Claims-based studies have documented substantial economic burden of opioid abuse. This study utilized electronic health record (EHR) data to identify chronic opioid therapy (COT) patients with problem opioid use (POU) and compared costs with those for COT patients without POU. ⋯ The largest cost difference was observed in the first month of follow-up. COT patients with POU experienced significantly higher costs compared with COT patients without POU in the first year of follow-up. The greatest difference in costs was observed around identification of POU.