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Is Lack of Evidence the Problem?

      Whatever successes there have been for chronic opioid therapy, they are currently overshadowed by the consequences of indiscriminate prescribing. Lest anyone doubt that there is an urgent need to moderate opioid prescribing in the U.S., consider the following. Opioid prescribing in the U.S. increased 200-fold over a single decade, largely because of new prescribing for chronic pain.

      Administration Usde. Automation Of Reports And Consolidated Orders System (Arcos), Retail Drug Summary Report. Available at: http://Www.Deadiversion.Usdoj.Gov/Arcos/Retail_Drug_Summary/Index.Html

      Efforts to identify an evidence base for chronic opioid therapy revealed only that the evidence supporting effectiveness for the therapy is weak.
      • Chou R.
      • Ballantyne J.C.
      • Fanciullo G.J.
      • Fine P.G.
      • Miaskowski C.
      Research Gaps On Use Of Opioids For Chronic Noncancer Pain: Findings From A Review Of The Evidence For An American Pain Society And American Academy Of Pain Medicine Clinical Practice Guideline.
      • Chou R.
      • Fanciullo G.J.
      • Fine P.G.
      • Adler J.A.
      • Ballantyne J.C.
      • Davies P.
      • Donovan M.I.
      • Fishbain D.A.
      • Foley K.M.
      • Fudin J.
      • Gilson A.M.
      • Kelter A.
      • Mauskop A.
      • O'Connor P.G.
      • Passik S.D.
      • Pasternak G.W.
      • Portenoy R.K.
      • Rich B.A.
      • Roberts R.G.
      • Todd K.H.
      • Miaskowski C.
      Clinical Guidelines For The Use Of Chronic Opioid Therapy In Chronic Noncancer Pain.
      Prescription opioid abuse in the U.S. has increased in parallel, to the extent that it has overtaken illicit opioid (heroin) abuse, and is regarded by the regulatory authorities as a significant societal problem.
      • Kuehn B.M.
      Opioid Prescriptions Soar: Increase In Legitimate Use As Well As Abuse.

      Office Of Applied Studies. National Survey On Drug Use And Health. Substance Abuse And Mental Services Administration (Samhsa) 2004. Available at: http://Wwwoassamhsagov/Nsduh/2k4nsduh/2k4results/2k4resultshtm

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      References

      1. Administration Usde. Automation Of Reports And Consolidated Orders System (Arcos), Retail Drug Summary Report. Available at: http://Www.Deadiversion.Usdoj.Gov/Arcos/Retail_Drug_Summary/Index.Html

        • Ballantyne J.C.
        Opioids For Chronic Pain: Taking Stock.
        Pain. 2006; 125: 3-4
      2. Chapman CR, Lipschitz DL, Angst MS, Chou R, Denisco RC, Donaldson GW, Fine PG, Foley KM, Gallagher RM, Gilson AM, Haddox JD, Horn SD, Inturrisi CE, Jick SS, Lipman AG, Loeser JD, Noble M, Porter L, Rowbotham MC, Schoelles KM, Turk DC, Volinn E, Von Korff MR, Webster LR, Weisner CM. Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base. J Pain 2010 April 27;[Epublication ahead of print]

        • Chou R.
        • Ballantyne J.C.
        • Fanciullo G.J.
        • Fine P.G.
        • Miaskowski C.
        Research Gaps On Use Of Opioids For Chronic Noncancer Pain: Findings From A Review Of The Evidence For An American Pain Society And American Academy Of Pain Medicine Clinical Practice Guideline.
        J Pain. 2009; 10: 147-159
        • Chou R.
        • Fanciullo G.J.
        • Fine P.G.
        • Adler J.A.
        • Ballantyne J.C.
        • Davies P.
        • Donovan M.I.
        • Fishbain D.A.
        • Foley K.M.
        • Fudin J.
        • Gilson A.M.
        • Kelter A.
        • Mauskop A.
        • O'Connor P.G.
        • Passik S.D.
        • Pasternak G.W.
        • Portenoy R.K.
        • Rich B.A.
        • Roberts R.G.
        • Todd K.H.
        • Miaskowski C.
        Clinical Guidelines For The Use Of Chronic Opioid Therapy In Chronic Noncancer Pain.
        J Pain. 2009; 10: 113-130
        • Eriksen J.
        • Sjogren P.
        • Bruera E.
        • Ekholm O.
        • Rasmussen N.K.
        Critical Issues On Opioids In Chronic Non-Cancer Pain. An Epidemiological Study.
        Pain. 2006; 125: 172-179
        • Hall A.J.
        • Logan J.E.
        • Toblin R.L.
        • Kaplan J.A.
        • Kraner J.C.
        • Bixler D.
        • Crosby A.E.
        • Paulozzi L.J.
        Patterns Of Abuse Among Unintentional Pharmaceutical Overdose Fatalities.
        Jama. 2008; 300: 2613-2620
        • Katz N.
        • Panas L.
        • Kim M.
        • Audet A.D.
        • Bilansky A.
        • Eadie J.
        • Kreiner P.
        • Paillard F.C.
        • Thomas C.
        • Carrow G.
        Usefulness Of Prescription Monitoring Programs For Surveillance–Analysis Of Schedule Ii Opioid Prescription Data In Massachusetts, 1996-2006.
        Pharmacoepidemiol Drug Saf. 2010; 19: 115-123
        • Kuehn B.M.
        Opioid Prescriptions Soar: Increase In Legitimate Use As Well As Abuse.
        Jama. 2007; 17: 249-251
      3. Office Of Applied Studies. National Survey On Drug Use And Health. Substance Abuse And Mental Services Administration (Samhsa) 2004. Available at: http://Wwwoassamhsagov/Nsduh/2k4nsduh/2k4results/2k4resultshtm

        • Podichetty V.K.
        • Weiss L.T.
        • Fanciullo G.J.
        • Baird J.C.
        Web-Based Health Survey Systems In Outcome Assessment And Management Of Pain.
        Pain Med. 2007; 8: S189-S198
        • Spence D.
        Bad Medicine: Pain.
        Br Med J. 2010; 340: B5683
        • Van Zee A.
        The Promotion And Marketing Of Oxycontin: Commercial Triumph, Public Health Tragedy.
        Am J Public Health. 2009; 99: 221-227
        • Wilsey B.L.
        • Fishman S.M.
        • Casamalhuapa C.
        • Gupta A.
        Documenting And Improving Opioid Treatment: The Prescription Opioid Documentation And Surveillance (Pods) System.
        Pain Med. 2009; 10: 866-877