DEA required drug test of chronic pain patient

[Qadgop_the_Mercotan]

Here’s a good review commentary on the use of opioids for chronic pain: Opioids for Chronic Pain: First Do No Harm

Key points:

1. The volume of prescribed opioids has increased 600% from 1997 to 2007.

2. During roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350%, from approximately 4,000 in 1999 to more than 14,000 in 2007.

3. Risk of overdose or death increases with higher doses of opioids, especially in patients who concurrently use other respiratory depressants such as benzodiazepines.

4. There are treatments for chronic pain that are much safer than opioids, including, but not limited to, physical therapy, cognitive behavioral therapy, low-dose tricyclic medications, and treatment of co-occurring psychiatric illnesses.

5. High doses of opioids do not reliably decrease patients’ report of the magnitude of chronic pain, nor do they improve patients’ overall health and function.

Thus it is reasonable to conclude that opioids for chronic noncancer pain are not appropriate therapy for most patients in primary care settings. When other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy requires a long-term commitment by clinician and patient alike to use this powerful, precious, and dangerous medication with care and diligence. As clinicians and as patients, we need to develop a generous measure of respect for the power of opioids to do harm as well as provide relief from pain.

Primum non nocere! (Kill as few patients as possible)