Balanced Pain Management and Overdose Prevention Strategies

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The FDA commissioner recently announced the formation of an Opioid Policy Steering Committee to “explore and develop additional tools or strategies [the] FDA can use to confront this crisis.”
The FDA commissioner recently announced the formation of an Opioid Policy Steering Committee to “explore and develop additional tools or strategies [the] FDA can use to confront this crisis.”
The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor's conference coverage.

LAS VEGAS – At PAINWeek 2017, held September 5-9, Lisa McElhaney, BS, president of the National Association of Drug Diversion Investigators (NADDI), discussed ways to balance pain management needs and overdose prevention measures.1

Ms McElhaney noted the alarming increase in drug abuse, misuse, and addiction prevalence; the associated surge in overdose and mortality rates; and the role of healthcare providers in the prevention, intervention, and treatment of these issues. She clarified the definition of drug addiction as a “chronic, often relapsing brain disease that characterizes compulsive drug-seeking and use, despite hamful consequences to the drug addict and those around them,” and highlighted statistics regarding overdose-related deaths. Reports indicate that drug overdose is now the top cause of death among Americans younger than 50, with an estimated 59,000 to 65,000 such deaths in 2016.2

The US Food and Drug Administration (FDA) commissioner recently announced the formation of an Opioid Policy Steering Committee to “explore and develop additional tools or strategies [the] FDA can use to confront this crisis.”3 He has tasked the steering committee with 3 questions to explore initially:

  • Should the FDA require mandatory education for healthcare professionals to ensure proper awareness of risks and the ability to facilitate further treatment when indicated?
  • Should the FDA develop standards (in collaboration with provider groups) regarding opioid prescription for different medical indications? For example, while certain circumstances require a 30-day supply of opioids, other circumstances require only a 2- or 3-day course of treatment.
  • Is the FDA “doing enough when we evaluate new opioid drugs for market authorization, and do we need additional policies in this area” to consider the risk of abuse and misuse in the drug evaluation process?

Ms McElhaney reviewed approaches that would encourage the use of safe pain management practices to reduce risk.4 They include the following:

  • Extensive patient and physician education regarding the risk of abuse associated with opioids
  • Prescription monitoring programs that would detect patients “shopping” for physicians or pharmacies
  • Systems to detect medical errors and inappropriate prescribing practices
  • Contracts between patients and physicians regarding opioid treatment
  • Requirement of photo identification to fill an opioid prescription
  • Urine drug toxicology screening
  • Protocols pertaining to the safe disposal of any unused opioids
  • Referrals to pain and addiction specialists when indicated

She explained that a balanced approach to pain management involves a multifaceted, individualized treatment plan for each patient, including the use of various options to “address the physical, emotional, social, and psychological aspects of pain,” so that patients can learn to manage their pain in “safe, effective, responsible, and healthy ways to improve or maintain their overall well-being,” as stated by the Alliance for Balanced Pain Management.5

Read more of Clinical Pain Advisor's coverage of PAINWeek 2017 by visiting the conference page.

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References

  1. McElhaney L. Balanced Pain Management & Overdose Prevention Strategies. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, Nevada.
  2. Katz J. Drug deaths in America are rising faster than ever. The New York Times. 2017. www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html. Accessed September 5, 2017.
  3. Gottlieb S. FDA commissioner asks staff for ‘more forceful steps' to stem the opioid crisis. 2017. https://blogs.fda.gov/fdavoice/index.php/2017/05/fda-commissioner-asks-staff-for-more-forceful-steps-to-stem-the-opioid-crisis. Accessed September 5, 2017.
  4. Hahn K. Strategies to prevent opioid misuse, abuse, and diversion that may also reduce the associated costs. Am Health Drug Benefits. 2011; 4(2):107-114.
  5. Alliance for Balanced Pain Management. What is balanced pain management? 2013. http://alliancebpm.org/educate. Accessed September 5, 2017. 
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