Open AccessWhat is the Role of Urine Drug Testing (UDT) in the Management of Chronic Non‐Cancer Pain with Opioids?
Author(s) -
SCHONWALD GABRIEL
Publication year - 2012
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2012.01440.x
Subject(s) - medicine , addiction , medical prescription , cancer pain , chronic pain , opioid , certification , addiction medicine , hydromorphone , psychiatry , family medicine , alternative medicine , intensive care medicine , nursing , law , receptor , pathology , political science
There is no longer doubt that the misuse, abuse, addiction, and diversion of prescription opioids comprise a national epidemic [1]. A simple solution is unlikely. As HL Mencken stated, “For every complex problem, there is an answer that is clear, simple, and wrong.”In retrospect, the quandary we are in was predictable. Physicians practicing in the 1990s received minimal education in pain management and almost no training in addiction medicine; they were given a Drug Enforcement Administration (DEA) certification without their having demonstrated any knowledge base of safe opioid prescribing. A few physicians with expertise in managing cancer pain with opioids suggested that a subpopulation of patients with chronic pain of nonmalignant nature might benefit from long-term opioid treatment to decrease pain and improve function. With little evidence base [2], this model became common practice among many physicians. This model was promoted by the pharmaceutical industry, which saw an opportunity to expand its market. Third-party payers and society were seduced by the relatively low cost of opioids as a simple solution to a complex problem. While the cost of opioids is relatively low, managing the adverse effects and the current opioid prescription epidemic is proving to be very costly in lives and treasure.In view of the alarming rise of emergency department admissions and unintentional overdose deaths due to prescription opioids, the Office of National Drug Control Policy (ONDCP) and the American Society of Addiction Medicine (ASAM) issued statements supporting mandatory education in safe opioid prescribing as a prerequisite for DEA certification. The American Academy of Pain Medicine (AAPM) demonstrated its leadership by developing a comprehensive prescriber education curriculum that provides responsible, multidimensional solutions for prescribers, patients, and society. It offered a 2-day Safe Opioid Prescribing course at its 2012 Annual Meeting [3], cochaired by Drs. Lynn …