title: Prescribing opioids in primary care: Safely starting, monitoring, and stopping.
abstract: Chronic noncancer pain is common and often managed in the outpatient setting with chronic opioid therapy, even though the efficacy of this approach is uncertain and adverse effects are common. Some patients report meaningful benefit from opioids, but prescription drug abuse has reached epidemic proportions, and many suffer harm from opioid misuse, abuse, and diversion. Primary care providers and their care teams often struggle to balance these risks and benefits with little outside support. The authors review common challenges when starting, monitoring, and discontinuing opioids, and offer strategies for risk-reduction and patient communication.
authors.affiliation: Assistant Professor, Yale University School of Medicine, Yale-New Haven Hospital, Saint Raphael's Campus, New Haven, CT, USA. E-mail: daniel.tobin@yale.edu.|Medical Director, Adult Primary Care Center, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Tobin
authors.affiliation: Associate Professor of Medicine, University of Connecticut, Farmington, CT, USA.|Associate Program Director Categorical Internal Medicine, Director of Ambulatory Education, UConn Health, Farmington, CT, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Andrews
authors.affiliation: VA Connecticut Healthcare System, New Haven, CT, USA.|Assistant Professor, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods*; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D012449:Safety
chemical_list: D000701:Analgesics, Opioid