title: Are Physicians Safely Prescribing Opioids for Chronic Noncancer Pain? A Systematic Review of Current Evidence.
abstract: BACKGROUND
  With rising prescription of opioid medications for chronic noncancer pain (CNCP) in the past years, opioid abuse and overdose deaths have increased in parallel. To ensure adequate treatment outcomes and reduce the risks linked with the chronic use of opioids, practitioner's adherence to treatment guidelines is essential. This study summarizes published recommendations about the strategies to reduce the risks associated with the chronic use of opioids and evaluates the adherence of physicians to these recommendations.
  
  
  METHODS
  A systematic literature search was undertaken in May 2014 using major databases. Studies were included if they examined the adherence of practitioners with at least one form of opioid risk reduction strategy. Benchmark guidelines cited in these studies were also reviewed.
  
  
  RESULTS
  The search yielded 683 records, 14 of which were found to evaluate adherence of physicians to opioid risk reduction strategies. Nine benchmark guidelines were found. Almost all physicians consider opioid therapy only when other safer approaches have failed and do not prescribe opioids at doses greater than 200 mg/day of morphine equivalent. Unfortunately, less than 50% assess pain intensity using a pain scale; they often consider transdermal fentanyl safe for opioid-naïve patients and fail to discontinue opioids if they were ineffective in relieving patients' pain.
  
  
  CONCLUSIONS
  Substantial practice and knowledge gaps were identified, including the use of pain scales and prescription of transdermal fentanyl in opioid-naïve patients, which have important implications for patient's safety. Guidelines more practical to physicians' settings and further education of physicians are warranted.
authors: Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.
authors: Juliana
authors: J
authors: Tournebize
authors: Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.
authors: Valérie
authors: V
authors: Gibaja
authors: Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.
authors: Amandine
authors: A
authors: Muszczak
authors: Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.|Department of Psychiatry and Clinical Psychology, Nancy University Medical Center, Université de Lorraine, Lorraine, France.
authors: Jean-Pierre
authors: JP
authors: Kahn
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D062787:Drug Overdose; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D006801:Humans; D009293:Opioid-Related Disorders; D061214:Patient Safety; D010820:Physicians
chemical_list: D000701:Analgesics, Opioid
keywords: best practice guidelines; chronic noncancer pain; opioid analgesics; systematic review