title: Reducing opioid analgesic deaths in America: what health providers can do.
abstract: BACKGROUND
  Available data have shown steady increases of drug overdose deaths between 1992 and 2011. We review evidenced-based recommendations provided by a few prominent North American pain societies and suggest ways on how health providers might help reduce opioid analgesic deaths by implementing these practices.
  
  
  OBJECTIVE
  To identify health care providers' roles in reducing opioid analgesic deaths.
  
  
  METHODS
  A comprehensive review of current literature.
  
  
  METHODS
  The review included relevant literature identified through searches of MEDLINE, Cochran reviews, and Google Scholar, PubMed and EMBASE from January 1998 to January 2014. The level of evidence was classified as I (good), II (fair), and III (limited) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
  
  
  RESULTS
  Several practices such as too high doses overall, giving too high doses to opioid naive patients, too fast opioid titration, insufficient use and knowledge of urine drug testing, not updating knowledge of drug metabolism/interactions, and inadequate patient monitoring are associated with higher risks of opioid analgesic deaths. Suboptimal risk stratification of patients, rotation practices, and use of opioids analgesics in chronic noncancer pain are also associated factors.
  
  
  CONCLUSIONS
  There were a paucity of good evidence studies which show recommendations reduce death.
  
  
  CONCLUSIONS
  Providers should be aware of all associated factors with opiate analgesic deaths and apply the available evidence in reducing opioid analgesic deaths.
authors.affiliation: UCSD Center for Pain Medicine, La Jolla CA; Algone Pain Center, Wasila, Alaska; Dept. of Psychiatry, University of California, San Diego; Dept. Of Psychiatry, Harlem Hospital, Columbia University, NY.
authors.forename: Taghogho
authors.initials: T
authors.lastname: Agarin
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Trescot
authors.forename: Aniefiok
authors.initials: A
authors.lastname: Agarin
authors.forename: Doreena
authors.initials: D
authors.lastname: Lesanics
authors.forename: Claricio
authors.initials: C
authors.lastname: Decastro
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000401:mortality*; D062787:Drug Overdose / Q000401:mortality* / Q000517:prevention & control; D006282:Health Personnel / Q000592:standards; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000401:mortality; D015813:Substance Abuse Detection / Q000379:methods / Q000401:mortality / Q000592:standards; D014481:United States / Q000453:epidemiology
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid