Continuing evolution of opioid use in primary care practice: implications of emerging technologies

Abstract

Background:

Primary care physicians, nurse practitioners, and nurses are often the first to evaluate patients with pain and many patients depend on these clinicians for pain relief. The growing evidence supporting use of opioids for appropriately selected patients means that primary care practitioners must be knowledgeable regarding ever-evolving pain-management strategies.

Scope:

This review summarizes core considerations in opioid prescribing in the primary care setting, the risks of undertreatment of pain, the challenges and barriers associated with prescribing opioids, identifying risk factors that may predict problematic use, and emerging formulation technologies expected to assist clinicians in better achieving effective pain control while minimizing risks for misuse or diversion.

Results:

Primary care physicians face considerable challenges in optimizing pain management while minimizing potential for misuse, abuse and diversion. Opioid treatment decisions are based not only on the type of pain but also the patient’s psychosocial history, including a screening for predicting aberrant behaviors and, in some patients, substance abuse. New opioid formulations are available to assist clinicians in achieving adequate patient relief while reducing risk of tampering and abuse. Primary care practitioners need to be aware of these new options and integrate them into clinical treatment decisions.

Conclusions:

The strategic use of new opioid formulations and better patient assessment may lead to more successful use of opioids in the management of pain, while limiting or lowering the risk of the development of an addiction problem, abuse or diversion.

Key words::

• Analgesics
• Drug abuse
• Opioid formulations
• Opioids
• Primary care
• Substance abuse

Transparency

Declaration of funding

Funding for medical writing and editorial support was provided by Pfizer Inc.

Declaration of financial/other relationships

S.S. has declared that he received no funding for his part in the preparation and writing of this article. He also declares the following commercial interests: speaker for Endo Pharmaceuticals Inc., Janssen/Ortho-McNeil, Lilly, and Purdue Pharma LP; consultant for Covidien, Endo Pharmaceuticals Inc., GlaxoSmithKline, Janssen/Ortho-McNeil, MyMatrixx, Nuvo, and Pfizer Inc.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

Writing assistance was provided by Jonathan Kamien PhD, and editorial assistance was provided by Ogilvy CommonHealth Scientific Communications, Jennifer Van Winckel at Quintiles Medical Communications, Parsippany, NJ, USA, and was funded by King Pharmaceuticals, Inc., which was acquired by Pfizer Inc. in March 2011. Editorial assistance was also provided by Diane Hoffman PhD, at UBC Scientific Solutions, Southport, CT, USA, and was funded by Pfizer Inc.

Notes

*Talwin Nx is a registered trade name of Winthrop Pharmaceuticals, Sanofi-Aventis US LLC, New York, NY, USA.

†Exalgo is a registered trade name of Mallinckrodt Brand Pharmaceuticals, Inc., a Covidien company, Hazelwood, MO, USA.

†Butrans is a registered trade name of Purdue Pharma LP, Stamford, CT, USA.

‡Opana is a registered trade name of Endo Pharmaceuticals, Chadds Ford, PA, USA.

§Oxycontin is a registered trade name of Purdue Pharma LP, Stamford, CT, USA.

¶Oxecta is a registered trade name of King Pharmaceuticals, Inc, Bristol, TN, USA, which was acquired by Pfizer Inc, New York, NY, USA in March 2011.

∥Roxicodone is a registered trade name of Xanodyne Pharmaceuticals Inc., Newport, KY, USA.

⊥Embeda is a registered trade name of King Pharmaceuticals, Inc., Bristol, TN, USA, which was acquired by Pfizer Inc, New York, NY, USA in March 2011. King Pharmaceuticals, Inc. voluntarily recalled from U.S. wholesalers and retailers all dosage forms of Embeda because a pre-specified stability requirement was not met during routine testing; efforts are being made to resolve the issue.