/pdf/cdc-guideline-for-prescribing-opioids-for-chronic-pain-48d7kdjqlr.pdf

CDC guideline for prescribing opioids for chronic pain

Linking Research and Service Delivery: The Unique Mission of the Substance Abuse and Mental Health Services Administration: (495882006-006)

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.180209][2]][2]

KEY POINTS
Opioid use disorder is one of the most challenging forms of addiction facing the Canadian health care system, and a major contributor to the marked rises in opioid-related morbidity and death that Canada has been

/pdf/management-of-opioid-use-disorders-a-national-clinical-3ks2mxviwe.pdf

Management of opioid use disorders: a national clinical practice guideline

The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida

Treatment utilization among persons with opioid use disorder in the United States.

The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.

/pdf/american-society-of-addiction-medicine-asam-national-5e2lqil1ml.pdf

American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

BACKGROUND: Abuse of prescription medications is an ever-expanding epidemic in the United States. OBJECTIVE: This study intends to help provide physicians with more knowledge about the behaviors that patients with a substance use disorder may exhibit in an effort to obtain medications. DESIGN: Patients who were willing to participate in the survey were interviewed by a physician. SETTING: Patients were screened, selected, and interviewed while participating in an inpatient rehabilitation program. RESULTS: Thirty-six patients completed the survey. There was a mean of 50.2 prescriptions per person. An average of 1.2 states was utilized by the surveyed patient population. There was an average of 2.11 providers seen per patient. Data show that 78% of patients surveyed utilized more than one pharmacy. The type of medications obtained by respondents were as follows: opioids, 35 (97.2%); sedative-hypnotics, 17 (47.4%); and amphetamines, 2 (5.5%). Seventy-five percent of patients (27 of the 36) stated that they feigned symptoms in attempts to obtain prescriptions. Two patients used a falsified (via mislabeling) magnetic resonance image of injury. Two patients paid a physician outright for the prescription. Three patients (8.3%) stated they would physically harm themselves in an attempt to obtain prescription medications. CONCLUSIONS: It may be noted that patients seeking prescription medications tend to utilize more than one physician and more than one pharmacy. On the basis of survey results, it seems that primary care and pain management physicians are considered the easiest venues to obtain prescription medications. It suggests that patients will go to great lengths to obtain prescription medications. Language: en

Prescription Medication Obtainment Methods and Misuse.

The American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management provides guidance on the identification and management of alcohol withdrawal in adults with varying degrees of syndrome severity. The guideline addresses both ambulatory and inpatient care and considers special patient populations. The Guideline was primarily developed following the RAND/UCLA Appropriateness Method (RAM), a process to determine the appropriateness of a set of clinical procedures. This process included a review of gray and empirical literature published between January 2012 and October 2017. Nineteen existing guidelines, 112 reviews, and 150 research studies were used to develop draft guideline statements that were assessed by a panel of physicians experienced in withdrawal management and representing a diverse range of settings and patient populations. Recommendations were included in the Guideline where consensus on appropriate clinical practice was identified by the panel. Areas where additional research would provide valuable information for determining best practices were highlighted.

Margaret Jarvis

Papers

American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

Prescription Medication Obtainment Methods and Misuse.

Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management.