title: Long-term opioid therapy reconsidered.
abstract: In the past 20 years, primary care physicians have greatly increased prescribing of long-term opioid therapy. However, the rise in opioid prescribing has outpaced the evidence regarding this practice. Increased opioid availability has been accompanied by an epidemic of opioid abuse and overdose. The rate of opioid addiction among patients receiving long-term opioid therapy remains unclear, but research suggests that opioid misuse is not rare. Recent studies report increased risks for serious adverse events, including fractures, cardiovascular events, and bowel obstruction, although further research on medical risks is needed. New data indicate that opioid-related risks may increase with dose. From a societal perspective, higher-dose regimens account for the majority of opioids dispensed, so cautious dosing may reduce both diversion potential and patient risks for adverse effects. Limiting long-term opioid therapy to patients for whom it provides decisive benefits could also reduce risks. Given the warning signs and knowledge gaps, greater caution and selectivity are needed in prescribing long-term opioid therapy. Until stronger evidence becomes available, clinicians should err on the side of caution when considering this treatment.
authors: Group Health Research Institute, Seattle, Washington 98101, USA. vonkorff.m@ghc.org
authors: Michael
authors: M
authors: Von Korff
authors: Andrew
authors: A
authors: Kolodny
authors: Richard A
authors: RA
authors: Deyo
authors: Roger
authors: R
authors: Chou
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D002908:Chronic Disease; D062787:Drug Overdose / Q000209:etiology; D011307:Drug Prescriptions / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000188:drug therapy*; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid