Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 31

Opioids are a class of substances which bind to the opioid receptor. They are commonly utilized in anesthesia, prescribed as analgesics, employed for the treatment of opioid use disorder, and available in illicit economies (heroin and both diverted and counterfeit pills). Although data support the use of opioids for acute pain, their effectiveness for chronic pain management is limited. Details regarding opioid prescribing for pain are beyond the scope of this Protocol though general principles of care include (i) treating pain with combination therapies (both opioid and nonopioid pharmaceuticals and nonpharmacologic management), and (ii) when opioids must be used, employ the lowest dose for the shortest duration.

Risks associated with opioid use include (i) tolerance (dose increase needed to maintain effect), (ii) dependence (withdrawal symptoms upon cessation), and (iii) overdose‐related morbidity and mortality. The risk of overdose is related not just to the opioid dose, but also to the concomitant use of other central nervous system (CNS) depressants (both prescribed and not prescribed) such as benzodiazepines, zolpidem and other sleep aids and alcohol. Therefore, individuals prescribed opioids for both chronic pain and addiction treatment should be co‐prescribed naloxone and instructed in its use. Naloxone is an opioid antagonist, most often administered via an intranasal route, which reverses opioid overdose.

A third of individuals prescribed opioids for chronic pain report misuse. Symptoms of misuse can include taking extra medication because of the effect, running out of prescriptions early, and crushing and snorting or injecting the medication. At most, 12% of individuals prescribed opioids for chronic pain develop an opioid use disorder. Opioid misuse can be a risk factor for the development of opioid addiction. Validated instruments, such as the Opioid Risk Tool, should be utilized when initiating opioid prescribing to assess and communicate misuse and addiction risk to patients.