title: A research agenda for enhancing appropriate opioid prescribing in primary care.
abstract: The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patient-centered, multi-modal treatment plans.
authors.affiliation: VA Connecticut Healthcare System, 151B, 950 Campbell Avenue, West Haven, CT, 06516, USA, william.becker@yale.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D035843:Biomedical Research / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D011307:Drug Prescriptions / Q000592:standards; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000592:standards*
chemical_list: D000701:Analgesics, Opioid