The appropriate and safe management of pain, and concerns about opioid overuse, abuse and overdose, have been making headlines for the past 20 years. Historically, opioids have been used for chronic non-cancer pain despite a lack of high-quality evidence for efficacy. Pain management societies and organizations (eg, THE Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) embraced pain as a “vital sign” in the mid-1990s and encouraged more aggressive use of opioids for chronic pain. The amount of prescription opioids sold in the US increased nearly 4-fold from 1999 to 2014, despite no increase in reported pain.
According to IMS Health, a firm that tracks national prescription statistics, the number of opioid prescriptions dispensed peaked in 2012. For the first time in 20 years, the IMS data indicated a 12% overall decline in US opioid dispensing since the peak. Tightening of federal regulations for opioid prescriptions (eg, moving hydrocodone to schedule II status) likely contributed to the decline. Experts note, however, that the level of prescribing is still very high – with a growing overdose epidemic including fatal overdoses, which reached 28,000 in 2014.
Regulators and the public are looking to clinicians to "do the right thing" regarding pain management, but the "right thing" has been a moving target. What actions are in the patient’s or public’s best interest, and in the best interest of the clinician and their professional practice? There are opposing pressures from 1) patients and pain management experts who advocate providing opioids for individuals with pain, and 2) families, caregivers, and regulatory officials, who want to prevent prescription drug diversion, abuse and overdose. Finding the right balance to provide safe and effective pain management is a “moral imperative,” professional responsibility, and duty of healthcare professionals.
- Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses
This CE activity was developed by The Rx Consultant, a publication of Continuing Education Network, Inc.
CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours. CE credit is automatically reported to CPE Monitor.
CE activities for Nurse Practitioners and Clinical Nurse Specialists:
This continuing education activity meets the requirements of:
The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
This is a pharmacotherapeutics/pharmacology CE activity.
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Requirements for CE Credit
- Discuss opioid use in the US today, and the potential barriers to obtaining legitimate opioid medications.
- Review the benefits and risks of using opioids for chronic pain; list risk factors for opioid overdose and death.
- List the elements of safe and effective opioid prescribing and explain how to integrate the use of a prescription drug monitoring program (PDMP) database when determining the validity of opioid prescriptions.
- Discuss how to effectively communicate with patients and prescribers in order to validate the legitimacy of an opioid prescription. Describe 2 indicators of potential prescription opioid diversion or misuse.
Chris Stock, PharmD, BCPP
Disclosure : Dr. Chris Stock report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.
Disclosure : Dr. Gasbarro report no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.
The CE Activity developed by The Rx Consultant