Table 1. Retail Sales of Opioid Medications (Grams of Medication) from 1997 to 2007.

Institute of Medicine (IOM). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press, Washington, DC, USA (2011).
Freburger JK, Holmes GM, Agans RP et al. The rising prevalence of chronic low back pain. Arch. Intern. Med. 169(3), 251-258 (2009).
Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract. Res. Clin. Rheumatol. 24(6), 783-792 (2010).
Manchikanti L, Abdi S, Atluri S et al.; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic noncancer pain: part I – evidence assessment. Pain Physician 15(Suppl. 3), S1-S65 (2012).
Manchikanti L, Abdi S, Atluri S et al.; American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic noncancer pain: part 2 – guidance. Pain hysician 15(Suppl. 3), S67-S116 (2012).
Manchikanti L, Helm II S, Fellows B et al. Opioid epidemic in the United States. Pain Physician 15(Suppl. 3), ES9-ES38 (2012).
•• Comprehensive description of the escalating epidemic of therapeutic use, abuse and nonmedical use of opioids.
Koyyalagunta D, Bruera E, Solanki DR et al. A systematic review of randomized trials on the effectiveness of opioids for cancer pain. Pain Physician 15(Suppl. 3), ES39-ES58 (2012).
Sehgal N, Manchikanti L, Smith HS. rescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician 15(Suppl. 3), ES67-ES92 (2012).
Owen GT, Burton AW, Schade CM, Passik S. Urine drug testing: current recommendations and best practices. Pain hysician 15(Suppl. 3), ES119-ES133 (2012).
Atluri S, Akbik H, Sudarshan G. Prevention of opioid abuse in chronic noncancer pain: an algorithmic, evidence based approach. Pain hysician 15(Suppl. 3), ES177-ES189 (2012).
Fischer B, Argento E. Prescription opioid related misuse, harms, diversion and interventions in Canada: a review. Pain Physician 15(Suppl. 3), ES191-ES203 (2012).
Roxburgh A, Bruno R, Larance B, Burns L. rescription of opioid analgesics and related harms in Australia. Med. J. Aust. 195(5), 280-284 (2011).
Manubay JM, Muchow C, Sullivan MA. rescription drug abuse: epidemiology, regulatory issues, chronic pain management with narcotic analgesics. Prim. Care 38(1), 71-90, vi (2011).
Strassels SA. Economic burden of prescription opioid misuse and abuse. J. Manag. Care harm. 15(7), 556-562 (2009).
Kuehn BM. Prescription drug abuse rises globally. JAMA 297(12), 1306 (2007).
Gupta S, Gupta M, Nath S, Hess GM. Survey of European pain medicine practice. Pain hysician 15(6), E983-E994 (2012).
Manchikanti L, Falco FJ, Singh V et al. Utilization of interventional techniques in managing chronic pain in the Medicare opulation: analysis of growth patterns from 2000 to 2011. Pain Physician 15(6), E969-E982 (2012).
Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997–2006. Spine 34(19), 2077-2084 (2009).
Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. Eur. Addict. Res. 18(5), 228-245 (2012).
Shield KD, Ialomiteanu A, Fischer B, Rehm J. Assessing the prevalence of non-medical prescription opioid use in the Canadian general adult population: evidence of large variation depending on survey questions used. BMC Psychiatry 13, 6 (2013).
Stafford N. At least 25% of elderly residents of German nursing homes are addicted to psychotropic drugs, report claims. BMJ 340, c2029 (2010).
Porteous T, Bond C, Hannaford P, Sinclair H. How and why are non-prescription analgesics used in Scotland? Fam. Pract. 22(1), 78-85 (2005).
Astals M, Domingo-Salvany A, Buenaventura CC et al. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst. Use Misuse 43(5), 612-632 (2008).
Højsted J, Sjøgren P. Addiction to opioids in chronic pain patients: a literature review. Eur. J. Pain 11(5), 490-518 (2007).
International Narcotics Control Board. Narcotic Drugs: Estimated World Requirement for 2001 – Statistics for 1999. United Nations, New York, NY, USA (2000).
Moulin DE, Clark AJ, Speechley M, Morley-Forster PK. Chronic pain in Canada – prevalence, treatment, impact and the role of opioid analgesia. Pain Res. Manag. 7(4), 179-184 (2002).
Eriksen J, Jensen MK, Sjøgren P, Ekholm O, Rasmussen NK. Epidemiology of chronic non-malignant pain in Denmark. Pain 106(3), 221-228 (2003).
CDC. Adult use of prescription opioid pain medications – Utah, 2008. MMWR Morb. Mortal. Wkly Rep. 59(6), 153-157 (2010).
Caudill-Slosberg MA, Schwartz LM, Woloshin S. Office visits and analgesic prescriptions for musculoskeletal ain in US: 1980 vs 2000. Pain 109(3), 514-519 (2004).
Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Trends in use of opioids for noncancer pain conditions 2000–2005 in commercial and Medicaid insurance plans: the TROUP study. Pain 138(2), 440-449 (2008).
Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet 354(9186), 1248-1252 (1999).
Luo X, Pietrobon R, Hey L. Patterns and trends in opioid use among individuals with back pain in the United States. Spine 29(8), 884-890; discussion 891 (2004).
CDC. Vital signs: overdoses of prescription opioid pain relievers – United States, 1999–2008. MMWR Morb. Mortal. Wkly Rep. 60(43), 1487-1492 (2011).
Paulozzi LJ, Weisler RH, Patkar AA. A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it. J. Clin. Psychiatry 72(5), 589-592 (2011).
Boudreau D, Von Korff M, Rutter CM et al. Trends in long-term opioid therapy for chronic noncancer pain. Pharmacoepidemiol. Drug Saf. 18(12), 1166-1175 (2009).
Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ 181(12), 891-896 (2009).
Manchikanti L, Cash KA, Malla Y, Pampati V, Fellows B. A prospective evaluation of psychotherapeutic and illicit drug use in patients presenting with chronic ain at the time of initial evaluation. Pain hysician 16(1), E1-E13 (2013).
Deyo RA, Smith DH, Johnson ES et al. Opioids for back pain patients: primary care prescribing atterns and use of services. J. Am. Board Fam. Med. 24(6), 717-727 (2011).
•• This review illustrates rescribing patterns and use of services that are under appreciated. The study also illustrates the relationship between commonality of prescription opioids in primary care with psychological distress, unhealthy lifestyles and increased utilization of healthcare services.
Ensuring availability of controlled medications for the relief of pain and preventing diversion and abuse: striking the right balance to achieve the optimal public health outcome. Discussion aper based on a scientific workshop. UNODC, Vienna, Austria, 18–19 January 2011.
Jones CM, Mack KA, Paulozzi LJ. harmaceutical overdose deaths, United States, 2010. JAMA 309(7), 657-659 (2013).
CDC. CDC grand rounds: prescription drug overdoses – a US epidemic. MMWR. Morb. Mortal. Wkly Rep. 61, 10-13 (2012).
Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA 284(4), 428-429 (2000).
Fauber J. Painkiller boom fueled by networking. J. Sentinel (2012).
Chou R, Huffman L. Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain: Evidence Review. American Pain Society, Glenview, IL, USA (2009).
Manchikanti L, Ailinani H, Koyyalagunta D et al. A systematic review of randomized trials of long-term opioid management for chronic noncancer pain. Pain Physician 14(2), 91-121 (2011).
Noble M, Treadwell JR, Tregear SJ et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst. Rev. CD006605 (2010).
Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic noncancer pain: systematic review of efficacy and safety. Pain 112(3), 372-380 (2004).
Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ 174(11), 1589-1594 (2006).
Manchikanti L, Vallejo R, Manchikanti KN, Benyamin RM, Datta S, Christo PJ. Effectiveness of long-term opioid therapy for chronic noncancer pain. Pain Physician 14(2), E133-E156 (2011).
Stein C, Reinecke H, Sorgatz H. Opioid use in chronic noncancer pain: guidelines revisited. Curr. Opin. Anaesthesiol. 23(5), 598-601 (2010).
Von Korff M, Kolodny A, Deyo RA, Chou R. Long-term opioid therapy reconsidered. Ann. Intern. Med. 155(5), 325-328 (2011).
Reinecke H, Sorgatz H; German Society for the Study of Pain (DGSS). S3 guideline LONTS. Long-term administration of opioids for nontumor pain. Schmerz 23(5), 440-447 (2009).
Sorgatz H, Maier C. Nothing is more damaging to a new truth than an old error: conformity of new guidelines on opioid administration for chronic pain with the effect prognosis of the DGSS S3 guidelines LONTS (long-term administration of opioids for non-tumor ain). Schmerz 24(4), 309-312 (2010).
Martell BA, O’Connor PG, Kerns RD et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann. Intern. Med. 146(2), 116-127 (2007).
Manchikanti L, Singh V, Caraway DL, Benyamin RM. Breakthrough pain in chronic noncancer pain: fact, fiction, or abuse. Pain Physician 14(2), E103-E117 (2011).
Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician 14(2), 145-161 (2011).
Okie S. A flood of opioids, a rising tide of deaths. N. Engl. J. Med. 363(21), 1981-1985 (2010).
Edlund MJ, Martin BC, Devries A, Fan MY, Braden JB, Sullivan MD. Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study. Clin. J. Pain 26(1), 1-8 (2010).
Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Risks for possible and robable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance lans: The TROUP Study. Pain 150(2), 332-339 (2010).
Sullivan MD. Limiting the potential harms of high-dose opioid therapy: comment on ‘Opioid dose and drug-related mortality in patients with nonmalignant ain’. Arch. Intern. Med. 171(7), 691-693 (2011).
Katz MH. Long-term opioid treatment of nonmalignant pain: a believer loses his faith. Arch. Intern. Med. 170(16), 1422-1424 (2010).
Dunn KM, Saunders KW, Rutter CM et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann. Intern. Med. 152(2), 85-92 (2010).
Saunders KW, Dunn KM, Merrill JO et al. Relationship of opioid use and dosage levels to fractures in older chronic pain atients. J. Gen. Intern. Med. 25(4), 310-315 (2010).
Walker JM, Farney RJ, Rhondeau SM et al. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J. Clin. Sleep Med. 3(5), 455-461 (2007).
Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for atients seeking care in US emergency departments. JAMA 299(1), 70-78 (2008).
American College of Emergency Physicians. Electronic prescription monitoring. Policy Statement. Ann. Emerg. Med. 59(3), 241-242 (2012).
Solanki DR, Koyyalagunta D, Shah RV, Silverman SM, Manchikanti L. Monitoring opioid adherence in chronic pain patients: assessment of risk of substance misuse. Pain Physician 14(2), E119-E131 (2011).
Christo PJ, Manchikanti L, Ruan X et al. Urine drug testing in chronic ain. Pain Physician 14(2), 123-143 (2011).
Manchikanti L, Malla Y, Wargo BW, Fellows B. Comparative evaluation of the accuracy of immunoassay with liquid chromatography tandem mass spectrometry (LC/MS/MS) of urine drug testing (UDT) opioids and illicit drugs in chronic pain patients. Pain hysician 14(2), 175-187 (2011).
Manchikanti L, Malla Y, Wargo BW, Fellows B. Comparative evaluation of the accuracy of benzodiazepine testing in chronic pain patients utilizing immunoassay with liquid chromatography tandem mass spectrometry (LC/MS/MS) of urine drug testing. Pain hysician 14(3), 259-270 (2011).
McCarberg BH. A critical assessment of opioid treatment adherence using urine drug testing in chronic ain management. Postgrad. Med. 123(6), 124-131 (2011).
Ling W, Mooney L, Hillhouse M. Prescription opioid abuse, ain and addiction: clinical issues and implications. Drug Alcohol Rev. 30(3), 300-305 (2011).
Hall AJ, Logan JE, Toblin RL et al. atterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 300(22), 2613-2620 (2008).
Toblin RL, Paulozzi LJ, Logan JE, Hall AJ, Kaplan JA. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J. Clin. sychiatry 71(4), 491-496 (2010).
Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379(9810), 55-70 (2012).
White AG, Birnbaum HG, Mareva MN et al. Direct costs of opioid abuse in an insured population in the United States. J. Manag. Care Pharm. 11(6), 469-479 (2005). genRefLink(8, 'ref-76', '15998164');
Birnbaum HG, White AG, Reynolds JL et al. Estimated costs of rescription opioid analgesic abuse in the United States in 2001: a societal perspective. Clin. J. ain 22(8), 667-676 (2006).
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 12(4), 657-667 (2011).
Hansen RN, Oster G, Edelsberg J, Woody GE, Sullivan SD. Economic costs of nonmedical use of prescription opioids. Clin. J. ain 27(3), 194-202 (2011).
Ghate SR, Haroutiunian S, Winslow R, McAdam-Marx C. Cost and comorbidities associated with opioid abuse in managed care and Medicaid patients in the United Stated: a comparison of two recently ublished studies. J. Pain Palliat. Care harmacother. 24(3), 251-258 (2010).
CDC. Overdose deaths involving prescription opioids among Medicaid enrollees – Washington, 2004–2007. MMWR Morb. Mortal. Wkly Rep. 58(42), 1171-1175 (2009).
White JA, Tao X, Talreja M, Tower J, Bernacki E. The effect of opioid use on workers’ compensation claim cost in the State of Michigan. J. Occup. Environ. Med. 54(8), 948-953 (2012).
Edlund MJ, Martin BC, Fan MY, Braden JB, Devries A, Sullivan MD. An analysis of heavy utilizers of opioids for chronic noncancer pain in the TROUP study. J. Pain Symptom Manage. 40(2), 279-289 (2010).
Katz N, Panas L, Kim M et al. Usefulness of prescription monitoring programs for surveillance–analysis of Schedule II opioid prescription data in Massachusetts, 1996–2006. Pharmacoepidemiol. Drug Saf. 19(2), 115-123 (2010).
Bohnert AS, Valenstein M, Bair MJ et al. Association between opioid rescribing patterns and opioid overdose-related deaths. JAMA 305(13), 1315-1321 (2011).
Lanier WA. Prescription opioid overdose deaths – Utah, 2008–2009. Presented at: 59th Annual Epidemic Intelligence Service Conference. Atlanta, GA, USA, 19–23 April 2010.
Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid rescriptions in 2009. JAMA 305(13), 1299-1301 (2011).
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: revalence, impact on daily life, and treatment. Eur. J. Pain 10(4), 287-333 (2006).
Manchikanti L, Hirsch JA. Obamacare 2012: rognosis unclear for interventional pain management. Pain Physician 15(5), E629-E640 (2012).
Fillingim RB, Doleys DM, Edwards RR, Lowery D. Clinical characteristics of chronic back pain as a function of gender and oral opioid use. Spine 28(2), 143-150 (2003).
Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine 32(19), 2127-2132 (2007).
Mahmud MA, Webster BS, Courtney TK, Matz S, Tacci JA, Christiani DC. Clinical management and the duration of disability for work-related low back pain. J. Occup. Environ. Med. 42(12), 1178-1187 (2000).
Franklin GM, Stover BD, Turner JA, Fulton-Kehoe D, Wickizer TM; Disability Risk Identification Study Cohort. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort. Spine 33(2), 199-204 (2008).
Rhee Y, Taitel MS, Walker DR, Lau DT. Narcotic drug use among atients with lower back pain in employer health plans: a retrospective analysis of risk factors and health care services. Clin. Ther. 29(Suppl.), 2603-2612 (2007).
Gross DP, Stephens B, Bhambhani Y, Haykowsky M, Bostick GP, Rashiq S. Opioid prescriptions in Canadian workers’ compensation claimants: rescription trends and associations between early rescription and future recovery. Spine 34(5), 525-531 (2009).
Volinn E, Fargo JD, Fine PG. Opioid therapy for nonspecific low back pain and the outcome of chronic work loss. Pain 142(3), 194-201 (2009).
Cifuentes M, Webster B, Genevay S, Pransky G. The course of opioid prescribing for a new episode of disabling low back pain: opioid features and dose escalation. Pain 151(1), 22-29 (2010).
Webster BS, Cifuentes M, Verma S, Pransky G. Geographic variation in opioid prescribing for acute, work-related, low back pain and associated factors: a multilevel analysis. Am. J. Ind. Med. 52(2), 162-171 (2009).
Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton-Kehoe D. Opioid use for chronic low back ain: a prospective, population-based study among injured workers in Washington state, 2002–2005. Clin. J. Pain 25(9), 743-751 (2009).
Becker N, Sjøgren P, Bech P, Olsen AK, Eriksen J. Treatment outcome of chronic non-malignant ain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial. Pain 84(2–3), 203-211 (2000).
Eriksen J, Sjøgren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic noncancer pain: an epidemiological study. Pain 125(1–2), 172-179 (2006).

• An insight into opioid use and its deleterious effects in a setting where there are no limits to providing opioids.
Volkow ND, McLellan TA. Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA 305(13), 1346-1347 (2011).
Paulozzi LJ, Stier DD. Prescription drug laws, drug overdoses, and drug sales in New York and ennsylvania. J. Public Health Policy 31(4), 422-432 (2010).
Paulozzi LJ, Kilbourne EM, Shah NG et al. A history of being prescribed controlled substances and risk of drug overdose death. Pain Med. 13(1), 87-95 (2012).
Paulozzi LJ, Kilbourne EM, Desai HA. rescription drug monitoring programs and death rates from drug overdose. Pain Med. 12(5), 747-754 (2011).
Franklin GM, Mai J, Turner J, Sullivan M, Wickizer T, Fulton-Kehoe D. Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am. J. Ind. Med. 55(4), 325-331 (2012).

Websites
201. Report of the International Narcotics Control Board for 2011. United Nations, New York, NY, USA (2012). www.unodc.org/documents/southasia/reports/2011_INCB_ANNUAL_REPORT_english_PDF.pdf (Accessed 4 February 2013)
202. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2010, Vienna, Austria: Division for Policy Analysis and ublic Affairs, United Nations Office on Drugs and Crime (UNODC) (2010). Report No. E.10XI.13. www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf (Accessed 4 February 2013)
203. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2011, Vienna, Austria: United Nations Office on Drugs and Crime (2011). www.unodc.org/documents/data-and-analysis/WDR2011/World_Drug_Report_2011_ebook.pdf (Accessed 4 February 2013)
204. CDC. Policy Impact: Prescription Painkiller Overdoses, November 2011. www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf (Accessed 4 February 2013)
205. Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS ublication No. (SMA) 12–4713. Substance Abuse and Mental Health Services Administration, Rockville, MD, USA (2012). www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm (Accessed 4 February 2013)
206. International Narcotics Control Board. Narcotic Drugs Technical Report: Estimated World Requirements for 2012 – Statistics for 2010. United Nations, New York, NY, USA (2011). www.incb.org/incb/en/narcotic-drugs/Technical_Reports/2011/narcotic-drugs-technical-report_2011.html (Accessed 4 February 2013)
206. National Center for Health Statistics. Health, United States, 2008. National Center for Health Statistics, Hyattsville, MD, USA (2009). www.cdc.gov/nchs/data/hus/hus08.pdf (Accessed 4 February 2013)
208. Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no. 81. National Center for Health Statistics, Hyattsville, MD, USA (2011). www.cdc.gov/nchs/data/databriefs/db81.pdf (Accessed 4 February 2013)
209. SDI, Vector One^®: National. www.sdihealth.com/vector_one/services.aspx (Accessed 4 February 2013)
210. US Government Accountability Office: Report to Congressional Requesters. Prescription Pain Reliever Abuse, December 2011. www.gao.gov/assets/590/587301.pdf (Accessed 4 February 2012)
• This study from Government Accountability Office illustrates key measures of rescription pain reliever abuse and misuse which increased enormously from 2003 to 2009. The manuscript also provides synthesis of various preventive measures.
211. Unintentional Drug oisoning in the United States. CDC, July 2010. www.cdc.gov/homeandrecreationalsafety/pdf/poison-issue-brief.pdf (Accessed 4 February 2013)
212. Ohio Department of Health. Epidemic of prescription drug overdose in Ohio (2010). www.healthyohioprogram.org/vipp/data/~/media/B36238B3B2C746308AA51232575613DD.ashx (Accessed 4 February 2012)
213. Federation of State Medical Boards of the US. Model guidelines for the use of controlled substances for the treatment of ain: a policy document of the Federation of State Medical Boards of the United States, Inc. Dallas, TX, USA (1998). www.medsch.wisc.edu/painpolicy/domestic/model.htm (Accessed 4 February 2013)
214. Letter to Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, US FDA, from Physicians for Responsible Opioid Prescribing RE Docket No. FDA-2011-D-0771, Draft Blueprint for Prescriber Education for Long-Acting/Extended Release Opioid Class-Wide Risk Evaluation and Mitigation Strategies. 2 December 2011. www.rxreform.org/wp-content/uploads/2011/11/ARPO-Statement-on-FDA-Draft-Blueprint-112911.pdf (Accessed 4 February 2013)
215. Methadone Mortality Working Group Drug Enforcement Administration, Office of Diversion Control, April 2007. www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdf (Accessed 4 February 2013)
216. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: final data for 2007. National Vital Statistics Reports. Volume 58 No. 19. National Center for Health Statistics, Hyattsville, MD, USA (2010). www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf (Accessed 4 February 2013)
217. National Health Services, The National Treatment Agency for Substance Misuse. Addiction to medicine. An investigation into the configuration and commissioning of treatment services to support those who develop problems with rescription-only or over-the-counter medicine. (2011). www.nta.nhs.uk/uploads/addictiontomedicinesmay2011a.pdf (Accessed 4 February 2013)
218. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episodes Data Set (TEDS) Highlights. National Admissions to Substance Abuse Treatment Services, Rockville, MD, USA (2005–2007). www.samhsa.gov/data/DASIS/TEDS2k7AWeb/TEDS2k7AWeb.pdf (Accessed 4 February 2013)
219. Magellan Health Services. White paper: taking on prescription drug abuse through customized state solutions across the care continuum. www.oregon.gov/oha/pharmacy/DocumentsArticlesPublications/Customized%20State%20Solutions%20%E2%80%93%20Magellan%20Health%20Services.pdf (Accessed 4 February 2013)
220. US Department of Justice, National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society (2011). www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf (Accessed 4 February 2013)
221. Baldasare A. The cost of prescription drug abuse: a literature review. Strategic Applications International. 6 January 2011. http://sai-dc.com/download/resources/20110106-cost-of-prescription-drug-abuse.pdf (Accessed 4 February 2013)
222. Centers for Medicare & Medicaid Services. Drug diversion in the Medicaid Program. State strategies for reducing rescription drug diversion in Medicaid. January 2012. www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf (Accessed 4 February 2013)
223. Public law No: 109–60. H.R.1132 signed by President George W. Bush on 11 August 2005. www.gpo.gov/fdsys/pkg/PLAW-109publ60/pdf/PLAW-109publ60.pdf (Accessed 4 February 2013)
224. U.S. Department of Justice, National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society. 2011. www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf (Accessed 4 February 2013)
225. Methadone Mortality Working Group Drug Enforcement Administration, Office of Diversion Control, April 2007. www.deadiversion.usdoj.gov/drugs_concern/methadone/methadone_presentation0407_revised.pdf (Accessed 4 February 2013)

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Author(s)

Laxmaiah Manchikanti, MD

Medical Director, Pain Management Center of Paducah, Paducah, Kentucky; Associate Clinical Professor, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky

Disclosures

Disclosure: Laxmaiah Manchikanti, MD, has disclosed no relevant financial relationships.

Mark V. Boswell, MD, PhD

Chairman, Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky

Disclosures

Disclosure: Mark V. Boswell, MD, PhD, has disclosed no relevant financial relationships.

Joshua A. Hirsch, MD

Vice Chief of Interventional Care, Department of Radiology, Massachusetts General Hospital; Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts

Disclosures

Disclosure: Joshua A. Hirsch, MD, has disclosed no relevant financial relationships.

Editor

Elisa Manzotti

Publisher, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD

Associate Professor and Residency Director, Department of Family Medicine, University of California-Irvine, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

CME

Lessons Learned in the Abuse of Pain-Relief Medication: A Focus on Health Care Costs

Authors: Laxmaiah Manchikanti, MD; Mark V. Boswell, MD, PhD; Joshua A. Hirsch, MD
CME Released: 4/29/2013
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 4/29/2014

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, pain management specialists, and other physicians who might prescribe opioid analgesics.

The goal of this activity is to evaluate the problem of opioid medication abuse and how to improve it.

Upon completion of this activity, participants will be able to:

Assess the epidemiology of prescription opioid abuse
Distinguish the health impact of prescription opioid abuse
Distinguish the economic impact of prescription opioid abuse
Identify means to reduce the risk of prescription opioid abuse

Disclosures

Author(s)

Laxmaiah Manchikanti, MD

Medical Director, Pain Management Center of Paducah, Paducah, Kentucky; Associate Clinical Professor, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky

Disclosures

Disclosure: Laxmaiah Manchikanti, MD, has disclosed no relevant financial relationships.

Mark V. Boswell, MD, PhD

Chairman, Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky

Disclosures

Disclosure: Mark V. Boswell, MD, PhD, has disclosed no relevant financial relationships.

Joshua A. Hirsch, MD

Vice Chief of Interventional Care, Department of Radiology, Massachusetts General Hospital; Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts

Disclosures

Disclosure: Joshua A. Hirsch, MD, has disclosed no relevant financial relationships.

Editor

Elisa Manzotti

Publisher, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD

Associate Professor and Residency Director, Department of Family Medicine, University of California-Irvine, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Expert Reviews, Ltd. Medscape is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

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What Has the Medical Profession Learned?

Nonmedical Use of Psychotherapeutic Drugs

The results of the National Survey on Drug Use and Health in the USA showed that in 2011, there was a 14% decline in prescription drug use for nonmedical purposes among people aged 18–25 years; this reflects the 300,000 fewer young adults abusing such drugs compared with last year’s survey.^[205] However, prescription abuse rates among children aged 12–17 years and adults over 26 years old remain unchanged. This survey showed that approximately 8.7% of Americans aged 12 years and older were identified as current drug users, a total of 22.5 million Americans; this was not a significant change from the previous year’s percent rate of 8.9%. Like previous years, marijuana continued to be the most commonly used illicit drug and its use appears to be on the rise. According to this survey, 7% of Americans were currently marijuana users, up from 6.9% in 2010 and 5.8% in 2007.^[205] Heroin use has reduced with the number of users falling to 620,000 in 2011 from 621,000 in 2010; however, there had been a substantial increase from 373,000 users in 2007. Further, in some areas, heroin is being substituted for prescription opioids.

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Overuse of Therapeutic Opioids

CME Information

Abstract and Introduction
What Has the Medical Profession Learned?
Overuse of Therapeutic Opioids
Consequences of Excessive Opioid Use
How Did We Get Here?
Impact on Healthcare Costs
Curtailing Opioid Abuse & Healthcare Costs
Expert Commentary
Five-Year View
Key Issues

References

Table 1. Retail Sales of Opioid Medications (Grams of Medication) from 1997 to 2007.

CME

Lessons Learned in the Abuse of Pain-Relief Medication: A Focus on Health Care Costs

Target Audience and Goal Statement

Disclosures

Author(s)

Laxmaiah Manchikanti, MD

Mark V. Boswell, MD, PhD

Joshua A. Hirsch, MD

Editor

Elisa Manzotti

CME Author

Charles P. Vega, MD

CME Reviewer

Nafeez Zawahir, MD