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Scope of Pain: Safe and Competent Opioid Prescribing Education

May 15, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

Earlier this week, more than 100 physicians, nurses, and other healthcare providers attended a three-hour educational session sponsored by Cape Cod Healthcare and presented by faculty from the Boston University School of Medicine. The purpose of the educational session was to provide health professionals with the tools they need to safely and effectively manage patients with chronic pain.

According to the training materials, “Undertreated chronic pain and prescription opioid misuse (i.e., overdose, addiction, diversion) are major national problems. Opioids are one tool for managing chronic pain but carry significant risk when misused.” The training “offers providers the essential education in how to safely and competently use opioids in the treatment of chronic pain focusing on effective communication skills as well as the potential risks and benefits of opioids and when and how to initiate, maintain, modify, continue or discontinue opioid therapy.”

Opioid Abuse and Misuse

Opioid medications used for the treatment of pain—such as Vicodin, Percocet, Oxycontin, and others—are among the most commonly prescribed medications in the U.S. Unfortunately, a significant amount of these medications are misused, which has fueled the current epidemic of deaths from prescription drug overdose. Additionally, abuse of prescription painkillers is connected with the recent surge in heroin use. 

Statistics from the Substance Abuse and Mental Health Services Administration are telling: an estimated 2.1 million people in the United States have a  substance use disorder related to prescription opioid pain relievers and an estimated 467,000 are addicted to heroin. In a survey conducted in 2011, people who abused or misused opioids were asked where they obtained their medications; the results are informative:

  • 55% obtained it free from a friend or relative
  • 11.4% bought it from a friend or relative
  • 4.8% took it from a friend or relative without asking
  • 4.4% got it from a drug dealer or stranger
  • 7.1% got it from another source
  • 17.3% got it from their physician

Interestingly, more than 71 percent obtained the drugs from a family member or friend, and when asked how their relative or friend got their medications, almost 80 percent said it was from their physician.

According to Nora Volkow, MD, Director of the National Institute on Drug Abuse, “We are seeing an increase in the number of people who are dying from overdoses, predominantly after abuse of prescribed opioid analgesics. This disturbing trend appears to be associated with a growing number of prescriptions in and diversion from the legal market.”

Dealing with the Supply

In 2013 more than 207 million prescriptions were written for opioid painkillers. Globally, the U.S. is the biggest consumer of these medications, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).

In a position paper, "Prescription Drug Abuse," published last year, the American College of Physicians (representing more than 140,000 internists) stated that, “Physicians and other health professionals with prescribing privileges are entrusted with the authority to use medications in the treatment of their patients and therefore have an important role to play in helping to ensure safe and effective use of this treatment option and the deterrence of its abuse.”

There is considerable scientific evidence that opioid pain medication is important for the treatment of acute pain related to injuries and during the period following surgical procedures. However, according to the Scope of Pain training program, the benefits and safety of using opioids to manage chronic pain have not been adequately studied. Further, opioids for chronic pain:

  • can be beneficial for some patients
  • can be harmful for some patients
  • are only one tool for helping patients manage their chronic pain
  • have common side effects and significant risk including overdose and addiction
  • should only be used when alternative safer treatments are not adequate

The Scope of Pain education was presented by Jane Liebschutz, MD, an expert in the management of chronic pain. In introducing the program, she noted that there are 100 million people in the U.S. with chronic pain and that treatment must be tailored to each person’s experience and needs. During the three-hour session, she reviewed how to appropriately assess an individual's level of pain and how various treatment options are working (or not working); and, how to determine that individual's risk for opioid misuse.

To better understand how the use of opioids may impact someone with chronic pain, the training session included information about a patient with lower back pain, and pain in her feet related to diabetes (diabetic neuropathy). Her medical history, initial treatment, and ongoing pain management was woven into the presentation.

Hopefully, physicians and other healthcare professionals who participated in the training sessions have a better understanding of how to balance the needs of their patients who suffer from chronic pain and the wider public health issue of opioid misuse and abuse.


MyTopCare: An educational site from Boston Medical Center with information about opioid use. Find out what your doctor is reading. 

American Chronic Pain Association: Provides education in pain management skills to people with pain, family and friends, and health care professionals. 

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