title: Basic concepts in opioid prescribing and current concepts of opioid-mediated effects on driving.
abstract: BACKGROUND
  Many patients with chronic pain receive substandard analgesic therapy. Incomplete or inadequate care often stems from physician fears of patient addiction and/or drug toxicity. As a result, many chronic pain patients are undertreated and have unrelieved pain that tempts them to overuse or to abuse prescribed pharmacologic treatments. In the last few years, educational efforts have targeted physicians who treat chronic, nonmalignant pain with information to improve prescribing strategies and to appreciate side effects. Additionally, opioid prescribing guidelines and educational programs, including World Health Organization-published guidelines for the management of cancer pain in 1986 and the American Pain Society's promotion of pain as the 5(th) vital sign, have increased the propensity of pharmacists, physicians, and pain specialists to dispense pain treatments.
  
  
  METHODS
  Controversial and evolving consequences from this explosion of prescription opioid use have emerged and are discussed in this review, including prescribing principles, opioid analgesic side effects, and driving concerns.
  
  
  CONCLUSIONS
  With additional appreciation for the untoward effects of chronic analgesia and a better understanding of opioid pharmacology, physicians can utilize pain management treatments in a safer and more effective manner.
authors.affiliation: Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Kaye
authors.affiliation: Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, New Orleans, LA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Elise C
authors.initials: EC
authors.lastname: Lofton
keywords: Analgesics—opioid; chronic pain; medication therapy management; opioid-related disorders