Opioid abuse has continued to increase at an alarming rate since the 1990 s. As documented by different medical specialties, medical boards, advocacy groups, and the
Drug Enforcement Administration, available evidence suggests a wide variance in chronic
opioid therapy of 90 days or longer in chronic non-
cancer pain. Part 1 describes evidence assessment.
OBJECTIVES: The objectives of
opioid guidelines as issued by the American Society of Interventional
Pain Physicians (ASIPP) are to provide guidance for the use of
opioids for the treatment of chronic non-
cancer pain, to produce consistency in the application of an
opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-
cancer pain, and to reduce the incidence of abuse and
drug diversion. The focus of these guidelines is to curtail the abuse of
opioids without jeopardizing non-
cancer pain management with
opioids.
RESULTS: 1) There is good evidence that non-medical use of
opioids is extensive; one-third of
chronic pain patients may not use prescribed
opioids as prescribed or may abuse them, and
illicit drug use is significantly higher in these patients. 2) There is good evidence that
opioid prescriptions are increasing rapidly, as the majority of prescriptions are from non-
pain physicians, many patients are on long-acting
opioids, and many patients are provided with combinations of long-acting and short-acting
opioids. 3) There is good evidence that the increased supply of
opioids, use of high dose
opioids, doctor shoppers, and patients with multiple comorbid factors contribute to the majority of the fatalities. 4) There is fair evidence that long-acting
opioids and a combination of long-acting and short-acting
opioids contribute to increasing fatalities and that even low-doses of 40 mg or 50 mg of daily
morphine equivalent doses may be responsible for emergency room admissions with overdoses and deaths. 5) There is good evidence that approximately 60% of fatalities originate from
opioids prescribed within the guidelines, with approximately 40% of fatalities occurring in 10% of drug abusers. 6) The short-term effectiveness of
opioids is fair, whereas the long-term effectiveness of
opioids is limited due to a lack of long-term (> 3 months) high quality studies, with fair evidence with no significant difference between long-acting and short-acting
opioids. 7) Among the individual drugs, most
opioids have fair evidence for short-term and limited evidence for long-term due to a lack of quality studies. 8) The evidence for the effectiveness and safety of chronic
opioid therapy in the elderly for chronic non-
cancer pain is fair for short-term and limited for long-term due to lack of high quality studies; limited in children and adolescents and patients with comorbid psychological disorders due to lack of quality studies; and the evidence is poor in pregnant women. 9) There is limited evidence for reliability and accuracy of screening tests for
opioid abuse due to lack of high quality studies. 10) There is fair evidence to support the identification of patients who are non-compliant or abusing
prescription drugs or
illicit drugs through urine
drug testing and prescription drug monitoring programs, both of which can reduce
prescription drug abuse or doctor shopping.
DISCLAIMER: The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."