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Pill and Needles

Opioids' dual nature as a benefit and a risk to health

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Opioids' have a dual nature as a benefit and a risk to health, function, and well-being; this dual nature needs to be taken into account in drug regulation, prescribing, and opioid stewardship.

The Commission therefore makes the following recommendations:

Recognizing the risks and benefits of opioids in the drug approval process

  • Consider risk of diversion risk and drug market interplay in approval review
    • Recommendation 2a: Drug approval agencies should more heavily weigh concerns about diversion of medications to illicit markets, and, the potential interplay of the medication’s supply with other legal and illegal drugs.

  • Conduct long-term, pragmatic trials on opioids’ risks and benefits
    • Recommendation 2b: Governments should invest in the type of studies of opioids and their impact on pain, function, and addiction that are specifically discouraged by current medication approval regulations: long-term clinical trials enrolling broadly representative samples of patients.

The care of chronic pain in an opioid crisis

  • Implement national strategies for the prevention and management of pain
    • Recommendation 2c: Nations should implement comprehensive strategies for the prevention and management of pain, of which opioid prescribing is but one part

  • Ameliorate adverse impact of prescribing policy on patient subpopulations
    • Recommendation 2d: Policies restricting opioids should be sensitive to the needs of current and future pain patients. 

Promoting opioid stewardship in medicine

  • Restore trust in medicine by leading safer prescribing initiatives
    • Recommendation 2e: To rebuild trust in medicine while helping patients at the same time, individual prescribers, health care organizations, and professional associations should actively implement safer opioid prescribing initiatives, whether they are under external pressure to do so or not.
  • Exploit electronic medical record systems to monitor and nudge prescribing
    • Recommendation 2f: Opioid stewardship initiatives should embrace mandatory prescription drug monitoring programs and prescribing “nudges”.

  • Expand opioid agonist therapy with reasonable controls to patients with OUD
    • Recommendation 2g: Availability of medications for OUD should be expanded. Even while doing so, addiction care providers should recognize that prescribing opioid agonist therapies as extensively as possible with as few constraints as possible will no more resolve the addiction crisis than it did the pain crisis.