title: Opioid management of pain: the impact of the prescription opioid abuse epidemic.
abstract: OBJECTIVE
  The greater emphasis on pain control over the last decade has been accompanied by increased opioid prescriptions and an epidemic of opioid abuse. This review examines the financial, regulatory, and clinical practice impact of the epidemic, the factors contributing to its growth, and strategies that may counter this public health crisis.
  
  
  RESULTS
  Despite the call for urgent practice change and the introduction of new initiatives such as electronic prescription monitoring and additional education programs for providers and patients, the evidence for improved outcomes are limited. There are also concerns that some patients may suffer from underprescribing as an unintended consequence of more stringent state and federal regulations. There is consensus that some form of universal precautions should be adopted for all patients, including those being treated for cancer-related pain, in order to better identify and manage those at risk of opioid abuse.
  
  
  CONCLUSIONS
  The opioid prescription abuse epidemic has precipitated calls for increased regulation. Clinicians can improve patient care and diminish opioid abuse by identifying patient risk factors, increasing vigilance and structure for those at risk, and providing interdisciplinary care for any patients coping in a maladaptive manner.
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Virginia, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Rauenzahn
authors.forename: Egidio
authors.initials: E
authors.lastname: Del Fabbro
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D009293:Opioid-Related Disorders / Q000175:diagnosis; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D064226:Prescription Drug Diversion / Q000517:prevention & control; D055553:Prescription Drugs; D012307:Risk Factors; D015813:Substance Abuse Detection
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs